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General NPI Number Information
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NPI Number | 1023494259
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Entity Type | Individual
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Provider Name | MICHAEL VAN L.AC
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Gender | Male
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Dates
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Enumeration Date | 08/11/2015
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Last Update Date | 08/11/2015
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Provider Practice Location Address
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Address Line | 16550 CATALONIA DR
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City | RIVERSIDE
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State | CA
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Zip | 92504-8701
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Country | US
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Telephone | 951-343-2848
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Fax | 951-343-2969
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Provider Business Mailing Address
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Address Line | 9901 INDIANA AVE STE 101
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City | RIVERSIDE
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State | CA
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Zip | 92503-5416
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Country | US
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Telephone | 951-343-2848
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Fax | 951-343-2969
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | AC 9368
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License Number State | CA
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