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General NPI Number Information
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NPI Number | 1003301433
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Entity Type | Organization
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Legal Business Name | AGLAIA ACUPUNCTURE PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 06/27/2018
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Last Update Date | 12/05/2023
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Provider Practice Location Address
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Address Line | 8929 S SEPULVEDA BLVD STE 100
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City | LOS ANGELES
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State | CA
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Zip | 90045-3616
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Country | US
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Telephone | 310-878-0789
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Fax |
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Provider Business Mailing Address
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Address Line | 8838 DE HAVILAND AVE
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City | LOS ANGELES
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State | CA
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Zip | 90045-4114
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Country | US
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Telephone | 818-428-9858
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | YUNUEN BERISTAIN
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Credential | L.AC.
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Telephone | 818-428-9858
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC17554
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License Number State | CA
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