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General NPI Number Information
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NPI Number | 1265983324
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Entity Type | Individual
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Provider Name | ANNA BACK L.AC.
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Gender | Female
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Dates
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Enumeration Date | 10/24/2016
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Last Update Date | 07/31/2025
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Provider Practice Location Address
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Address Line | 823 W 9TH ST # 815
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City | SAN PEDRO
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State | CA
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Zip | 90731-3603
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Country | US
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Telephone | 310-602-9518
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Fax |
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Provider Business Mailing Address
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Address Line | 2328 3RD ST APT 14
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City | SANTA MONICA
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State | CA
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Zip | 90405-3460
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Country | US
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Telephone | 310-602-9518
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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 | AC17369
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License Number State | CA
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