=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124426200
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WESTWOOD HEALING CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/05/2014
-----------------------------------------------------
Last Update Date | 12/05/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10921 WEYBURN AVE
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90024-2808
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 213-700-4580
-----------------------------------------------------
Fax | 213-455-2400
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10921 WEYBURN AVE
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90024-2808
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 213-700-4580
-----------------------------------------------------
Fax | 213-455-2400
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | EMILY LEE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 213-700-4580
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | AC13320
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------