Healthcare Provider Details

I. General information

NPI: 1740001197
Provider Name (Legal Business Name): CANOPY HEALING CENTER AND ACUPUNCTURE CLINIC INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2024
Last Update Date: 10/18/2024
Certification Date: 10/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

336 S EUCLID AVE
PASADENA CA
91101-3125
US

IV. Provider business mailing address

2621 KENNINGTON DR
GLENDALE CA
91206-1826
US

V. Phone/Fax

Practice location:
  • Phone: 818-640-2033
  • Fax:
Mailing address:
  • Phone: 818-640-2033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: MARLEE JACKSON
Title or Position: OWNER
Credential:
Phone: 818-640-2033