=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609284389
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SALUD NATURAL: ACUPUNCTURE & TRADITIONAL CHINESE HERBS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/26/2014
-----------------------------------------------------
Last Update Date | 07/26/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2670 E GAGE AVE SUITE # 1
-----------------------------------------------------
City | HUNTINGTON PARK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90255-7206
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-584-4230
-----------------------------------------------------
Fax | 323-584-4230
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2670 E GAGE AVE SUITE # 1
-----------------------------------------------------
City | HUNTINGTON PARK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90255-7206
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-584-4230
-----------------------------------------------------
Fax | 323-584-4230
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR/OWNER
-----------------------------------------------------
Name | DR. GARY H ARCHER
-----------------------------------------------------
Credential | O.M.D., H.M.D., L AC
-----------------------------------------------------
Telephone | 323-584-4230
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number | CA 2987
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------