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General NPI Number Information
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NPI Number | 1093076721
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Entity Type | Organization
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Legal Business Name | KELLY KROTINE LICENSED ACUPUNCTURIST
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Dates
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Enumeration Date | 05/29/2012
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Last Update Date | 05/29/2012
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Provider Practice Location Address
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Address Line | 4910 VAN NUYS BLVD. SUITE 104
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City | SHERMAN OAKS
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State | CA
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Zip | 91403
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Country | US
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Telephone | 818-981-3440
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Fax | 818-981-0436
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Provider Business Mailing Address
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Address Line | 4910 VAN NUYS BLVD. SUITE 104
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City | SHERMAN OAKS
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State | CA
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Zip | 91403
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Country | US
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Telephone | 818-981-3440
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Fax | 818-981-0436
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Authorized Official
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Title or Position | CHIEF EXECUTIVE/FINANCIAL OFFICER
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Name | KELLY KROTINE
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Credential | L.AC.
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Telephone | 818-981-3440
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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 | 14757
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License Number State | CA
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