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General NPI Number Information
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NPI Number | 1225373590
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Entity Type | Organization
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Legal Business Name | MEDICAL AND HEALING ARTS, INC
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Dates
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Enumeration Date | 11/27/2012
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Last Update Date | 11/27/2012
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Provider Practice Location Address
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Address Line | 515 E COMMONWEALTH AVE
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City | FULLERTON
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State | CA
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Zip | 92832-2020
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Country | US
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Telephone | 714-871-7118
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Fax | 714-871-3372
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Provider Business Mailing Address
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Address Line | 515 E COMMONWEALTH AVE
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City | FULLERTON
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State | CA
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Zip | 92832-2020
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Country | US
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Telephone | 714-871-7118
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Fax | 714-871-3372
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CARL WILLIAM BUCKHORN
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Credential | M.D.
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Telephone | 714-871-7118
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number | G73630
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License Number State | CA
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