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General NPI Number Information
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NPI Number | 1609164953
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Entity Type | Organization
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Legal Business Name | SANA VIDA LLC
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Dates
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Enumeration Date | 07/20/2011
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Last Update Date | 07/20/2011
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Provider Practice Location Address
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Address Line | 507 HWY 1431 E
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City | MARBLE FALLS
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State | TX
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Zip | 78654-5211
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Country | US
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Telephone | 830-693-6000
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Fax | 866-536-5184
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Provider Business Mailing Address
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Address Line | 507 HWY 1431 E
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City | MARBLE FALLS
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State | TX
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Zip | 78654
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Country | US
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Telephone | 830-693-6000
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Fax | 866-536-5184
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Authorized Official
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Title or Position | OWNER
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Name | PATTI MCCORMICK
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Credential | L.AC.
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Telephone | 830-693-6000
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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 | AC00340
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License Number State | TX
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