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General NPI Number Information
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NPI Number | 1053646240
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Entity Type | Organization
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Legal Business Name | PACIFIC TOTAL HEALTH ACUPUNCTURE, INC.
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Dates
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Enumeration Date | 10/06/2009
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Last Update Date | 10/06/2009
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Provider Practice Location Address
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Address Line | 2512 WALNUT AVE SUITE 4
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City | TUSTIN
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State | CA
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Zip | 92780-6944
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Country | US
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Telephone | 949-461-9594
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Fax |
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Provider Business Mailing Address
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Address Line | 22431 TARANTO
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City | LAGUNA HILLS
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State | CA
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Zip | 92653-1917
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Country | US
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Telephone | 949-461-9594
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Fax |
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Authorized Official
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Title or Position | PRESIDENT & CEO
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Name | MRS. SIYUAN TANG
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Credential | LAC
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Telephone | 949-228-4481
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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 | AC12355
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License Number State | CA
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