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General NPI Number Information
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NPI Number | 1174078927
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Entity Type | Individual
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Provider Name | CHERI GROSS LAC, LMT
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Gender | Female
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Dates
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Enumeration Date | 08/22/2016
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Last Update Date | 08/22/2016
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Provider Practice Location Address
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Address Line | 11710 WILSHIRE BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90025-1503
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Country | US
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Telephone | 310-995-2241
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Fax |
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Provider Business Mailing Address
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Address Line | 922 19TH ST UNIT F
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City | SANTA MONICA
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State | CA
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Zip | 90403-3339
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Country | US
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Telephone | 310-995-2241
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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 | AC 16960
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License Number State | CA
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