Healthcare Provider Details

I. General information

NPI: 1598119067
Provider Name (Legal Business Name): ACUPUNCTURE AND HERBAL HOLISTIC CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2016
Last Update Date: 04/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

827 DEEP VALLEY DR SUITE 103
ROLLING HILLS ESTATES CA
90274-3692
US

IV. Provider business mailing address

827 DEEP VALLEY DR SUITE 103
ROLLING HILLS ESTATES CA
90274-3692
US

V. Phone/Fax

Practice location:
  • Phone: 310-749-6971
  • Fax:
Mailing address:
  • Phone: 310-749-6971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC5194
License Number StateCA

VIII. Authorized Official

Name: DR. SEPIDEH LACKPOUR
Title or Position: PRESIDENT
Credential: PH.D., L.AC.
Phone: 310-749-6971