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General NPI Number Information
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NPI Number | 1487029070
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Entity Type | Organization
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Legal Business Name | WISE WELLNESS CENTER LLC
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Dates
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Enumeration Date | 12/08/2015
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Last Update Date | 12/08/2015
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Provider Practice Location Address
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Address Line | 5080 LOVERS LN SUITE C
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City | PORTAGE
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State | MI
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Zip | 49002-1570
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Country | US
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Telephone | 619-339-8407
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Fax |
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Provider Business Mailing Address
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Address Line | 5080 LOVERS LN SUITE C
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City | PORTAGE
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State | MI
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Zip | 49002-1570
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Country | US
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Telephone | 619-339-8407
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Fax |
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Authorized Official
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Title or Position | ACUPUNCTURIST
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Name | MELISSA ANN TOYOSHIMA
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Credential | L.AC.
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Telephone | 619-339-8407
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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 | 14827
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License Number State | CA
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