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General NPI Number Information
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NPI Number | 1073917530
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Entity Type | Organization
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Legal Business Name | MENLA ACUPUNCTURE AND ORIENTAL MEDICINE PLLC
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Dates
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Enumeration Date | 10/13/2014
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Last Update Date | 10/13/2014
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Provider Practice Location Address
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Address Line | 1827 PASEO SAN LUIS STE B
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City | SIERRA VISTA
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State | AZ
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Zip | 85635-4630
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Country | US
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Telephone | 520-803-0071
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Fax |
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Provider Business Mailing Address
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Address Line | 1827 PASEO SAN LUIS STE B
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City | SIERRA VISTA
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State | AZ
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Zip | 85635-4630
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Country | US
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Telephone | 520-803-0071
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Fax |
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Authorized Official
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Title or Position | MEMBER/ ACUPUNCTURIST
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Name | MS. DANIELA CHRIST VAN WART
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Credential | L.AC
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Telephone | 520-308-0071
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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 | 931
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License Number State | AZ
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