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General NPI Number Information
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NPI Number | 1225587074
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Entity Type | Organization
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Legal Business Name | EASTVALE ACUPUNCTURE AND HERBS, INC.
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Dates
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Enumeration Date | 09/21/2016
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Last Update Date | 09/21/2016
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Provider Practice Location Address
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Address Line | 800 MAGNOLIA AVE STE 114
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City | CORONA
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State | CA
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Zip | 92879-3123
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Country | US
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Telephone | 951-496-7699
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Fax |
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Provider Business Mailing Address
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Address Line | 800 MAGNOLIA AVE STE 114
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City | CORONA
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State | CA
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Zip | 92879-3123
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Country | US
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Telephone | 951-496-7699
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. SHARON TUNG CHIEN
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Credential | LAC
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Telephone | 951-496-7699
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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 | AC16029
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License Number State | CA
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