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General NPI Number Information
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NPI Number | 1548719743
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Entity Type | Individual
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Provider Name | AMY DIAMOND-BRIDGES L.AC., MATCM
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Gender | Female
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Dates
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Enumeration Date | 09/28/2016
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Last Update Date | 09/28/2016
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Provider Practice Location Address
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Address Line | 530 WILSHIRE BLVD STE 202B
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City | SANTA MONICA
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State | CA
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Zip | 90401-1427
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Country | US
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Telephone | 424-258-0858
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Fax |
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Provider Business Mailing Address
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Address Line | 11133 ROSE AVE APT 22
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City | LOS ANGELES
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State | CA
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Zip | 90034-6065
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Country | US
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Telephone | 424-258-0858
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 17186
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License Number State | CA
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