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General NPI Number Information
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NPI Number | 1386208908
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Entity Type | Organization
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Legal Business Name | CLASSICAL ACUPUNCTURE CLINIC
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Dates
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Enumeration Date | 04/29/2019
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Last Update Date | 04/29/2019
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Provider Practice Location Address
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Address Line | 1554 S SEPULVEDA BLVD STE 209
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City | LOS ANGELES
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State | CA
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Zip | 90025-3359
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Country | US
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Telephone | 310-473-2090
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Fax |
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Provider Business Mailing Address
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Address Line | 1554 S SEPULVEDA BLVD STE 209
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City | LOS ANGELES
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State | CA
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Zip | 90025-3359
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Country | US
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Telephone | 310-473-2090
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MONA DINARI
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Credential | L.AC
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Telephone | 310-473-2090
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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