Healthcare Provider Details

I. General information

NPI: 1952328882
Provider Name (Legal Business Name): AMY FLEETMAN L.AC., O.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12215 VENTURA BLVD SUITE 208
STUDIO CITY CA
91604-2533
US

IV. Provider business mailing address

12215 VENTURA BLVD SUITE 208
STUDIO CITY CA
91604-2533
US

V. Phone/Fax

Practice location:
  • Phone: 818-505-0816
  • Fax: 818-505-8623
Mailing address:
  • Phone: 818-505-0816
  • Fax: 818-505-8623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC4970
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: