Healthcare Provider Details

I. General information

NPI: 1619384559
Provider Name (Legal Business Name): LOPEZ ACUPUNCTURE @ INTEGRATED HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2014
Last Update Date: 07/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 LOPEZ ROAD
LOPEZ ISLAND WA
98261-8519
US

IV. Provider business mailing address

2108 FISHERMAN BAY RD APT D
LOPEZ ISLAND WA
98261-8519
US

V. Phone/Fax

Practice location:
  • Phone: 360-468-3239
  • Fax:
Mailing address:
  • Phone: 360-468-3239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC60074458
License Number StateWA

VIII. Authorized Official

Name: JULIENNE BATTALIA
Title or Position: OWNER
Credential: EAMP, LAC, LMP
Phone: 360-468-3239