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General NPI Number Information
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NPI Number | 1134553274
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Entity Type | Individual
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Provider Name | CARMEN LUISA DE JESUS L.AC., LMT
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Gender | Female
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Dates
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Enumeration Date | 08/26/2013
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Last Update Date | 08/26/2013
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Provider Practice Location Address
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Address Line | 2322 E 18TH ST
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City | BROOKLYN
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State | NY
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Zip | 11229-4417
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Country | US
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Telephone | 585-746-7677
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Fax |
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Provider Business Mailing Address
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Address Line | 22 E 17TH ST SUITE 511
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City | NEW YORK
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State | NY
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Zip | 10003-1901
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Country | US
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Telephone |
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Fax |
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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 | 25005059
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 018323
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License Number State | NY
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