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General NPI Number Information
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NPI Number | 1427432533
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Entity Type | Organization
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Legal Business Name | PATTY JOHNSON'S ACUPUNCTURE AND HERBS
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Dates
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Enumeration Date | 07/17/2015
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Last Update Date | 07/17/2015
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Provider Practice Location Address
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Address Line | 8645 HAVEN AVE STE 550
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-4865
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Country | US
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Telephone | 909-989-3223
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Fax | 909-989-4430
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Provider Business Mailing Address
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Address Line | 8645 HAVEN AVE STE 550
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-4865
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Country | US
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Telephone | 909-989-3223
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Fax | 909-989-4430
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Authorized Official
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Title or Position | OWNER
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Name | MS. PATTY JO JOHNSON
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Credential | L.AC.
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Telephone | 909-989-3223
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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 | AC 8096
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License Number State | CA
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