Healthcare Provider Details

I. General information

NPI: 1891021622
Provider Name (Legal Business Name): MASTER LU'S HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2009
Last Update Date: 10/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3220 S STATE ST
SALT LAKE CITY UT
84115-3836
US

IV. Provider business mailing address

3220 S STATE ST
SALT LAKE CITY UT
84115-3836
US

V. Phone/Fax

Practice location:
  • Phone: 801-463-1101
  • Fax: 801-463-1197
Mailing address:
  • Phone: 801-463-1101
  • Fax: 801-463-1197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: BETTE ARCARIS
Title or Position: OFFICE MANAGER/BILLING
Credential:
Phone: 801-463-1101