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General NPI Number Information
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NPI Number | 1467714923
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Entity Type | Organization
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Legal Business Name | MOJAVE HOLISTIC CLINIC
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Dates
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Enumeration Date | 06/11/2012
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Last Update Date | 06/11/2012
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Provider Practice Location Address
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Address Line | 22633 US HIGHWAY 18 # A
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City | APPLE VALLEY
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State | CA
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Zip | 92307-4371
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Country | US
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Telephone | 760-247-7148
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Fax | 760-247-7114
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Provider Business Mailing Address
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Address Line | 22633 US HIGHWAY 18 # A
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City | APPLE VALLEY
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State | CA
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Zip | 92307-4371
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Country | US
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Telephone | 760-247-7148
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Fax | 760-247-7114
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Authorized Official
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Title or Position | BUSINESS OWNER
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Name | MS. YIFANG LIU
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Credential |
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Telephone | 760-247-7148
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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 | AC5176
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License Number State | CA
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