Healthcare Provider Details

I. General information

NPI: 1063973584
Provider Name (Legal Business Name): SANTA MONICA SUPERIOR ACUPUNCTURE CLINIC INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2019
Last Update Date: 03/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1528 6TH ST STE 120
SANTA MONICA CA
90401-2564
US

IV. Provider business mailing address

1528 6TH ST STE 120
SANTA MONICA CA
90401-2564
US

V. Phone/Fax

Practice location:
  • Phone: 310-592-8911
  • Fax:
Mailing address:
  • Phone: 310-592-8911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL PULFORD
Title or Position: OFFICE MANGER
Credential:
Phone: 310-592-8911