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General NPI Number Information
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NPI Number | 1205088812
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Entity Type | Organization
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Legal Business Name | GREEN OASIS ACUPUNCTURE, INC
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Dates
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Enumeration Date | 10/14/2008
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Last Update Date | 10/14/2008
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Provider Practice Location Address
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Address Line | 1454 CLOVERFIELD BLVD SUITE 240
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City | SANTA MONICA
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State | CA
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Zip | 90404-2980
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Country | US
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Telephone | 310-857-8776
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Fax | 310-315-2135
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Provider Business Mailing Address
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Address Line | 1454 CLOVERFIELD BLVD SUITE 240
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City | SANTA MONICA
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State | CA
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Zip | 90404-2980
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Country | US
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Telephone | 310-857-8776
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Fax | 310-315-2135
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Authorized Official
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Title or Position | PRESIDENT/ACUPUNCTURIST
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Name | JILL R. LYTLE
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Credential | L.AC
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Telephone | 310-857-8776
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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 | AC11652
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License Number State | CA
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