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General NPI Number Information
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NPI Number | 1306170717
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Entity Type | Organization
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Legal Business Name | OPEN MIND MODALITIES ACUPUNCTURE, INC.
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Dates
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Enumeration Date | 10/01/2009
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Last Update Date | 02/19/2019
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Provider Practice Location Address
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Address Line | 24541 PACIFIC PARK DR STE 205
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City | ALISO VIEJO
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State | CA
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Zip | 92656
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Country | US
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Telephone | 949-215-5437
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Fax |
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Provider Business Mailing Address
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Address Line | 24541 PACIFIC PARK DR STE 205
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City | ALISO VIEJO
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State | CA
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Zip | 92656-3050
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Country | US
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Telephone | 949-215-5437
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MRS. RUTH ANN MCCARTY
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Credential | DACM, L.AC.
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Telephone | 949-422-1804
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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 | 7963
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License Number State | CA
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