=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457522286
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LARCHMONT TRADITIONAL MEDICINE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/19/2008
-----------------------------------------------------
Last Update Date | 04/07/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 435 N LARCHMONT BLVD
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90004-3043
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-462-4710
-----------------------------------------------------
Fax | 323-462-4702
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 435 N LARCHMONT BLVD
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90004-3043
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-462-4710
-----------------------------------------------------
Fax | 213-254-9034
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MR. JAMES E BLOOMFIELD
-----------------------------------------------------
Credential | L.AC.
-----------------------------------------------------
Telephone | 323-462-4710
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | AC9866
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------