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General NPI Number Information
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NPI Number | 1568167039
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Entity Type | Organization
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Legal Business Name | ACUPUNCTURE INTEGRATIVE MEDICINE
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Dates
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Enumeration Date | 04/03/2023
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Last Update Date | 04/03/2023
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Provider Practice Location Address
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Address Line | 24422 AVENIDA DE LA CARLOTA STE 105
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City | LAGUNA HILLS
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State | CA
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Zip | 92653-3434
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Country | US
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Telephone | 949-561-2761
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Fax | 949-446-8766
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Provider Business Mailing Address
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Address Line | 24422 AVENIDA DE LA CARLOTA
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City | LAGUNA HILLS
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State | CA
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Zip | 92653-3636
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Country | US
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Telephone | 949-561-2761
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Fax | 949-446-8766
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Authorized Official
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Title or Position | ACUPUNCTURIST
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Name | MS. SHOHREH OMIDI
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Credential | DAOM
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Telephone | 714-514-4639
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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 |
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License Number State |
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