Healthcare Provider Details

I. General information

NPI: 1790930683
Provider Name (Legal Business Name): WALNUT NATURAL HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2008
Last Update Date: 11/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18710 AMAR RD SUITE C
WALNUT CA
91789-4571
US

IV. Provider business mailing address

18710 AMAR RD SUITE C
WALNUT CA
91789-4571
US

V. Phone/Fax

Practice location:
  • Phone: 626-839-8578
  • Fax: 626-839-7001
Mailing address:
  • Phone: 626-839-8578
  • Fax: 626-839-7001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC9113
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC30187
License Number StateCA

VIII. Authorized Official

Name: MRS. MANLI WU
Title or Position: CLINICAL DIRECTOR
Credential: D.C, L. AC.
Phone: 626-839-8578