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General NPI Number Information
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NPI Number | 1649532300
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Entity Type | Organization
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Legal Business Name | THE TOTAL HEALTH CENTER, ACUPUNCTURE AND NATURAL MEDICINE, INC.
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Dates
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Enumeration Date | 06/08/2012
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Last Update Date | 06/08/2012
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Provider Practice Location Address
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Address Line | 10061 RIVERSIDE DR 811
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City | TOLUCA LAKE
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State | CA
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Zip | 91602-2560
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Country | US
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Telephone | 818-509-9233
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Fax | 818-301-0333
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Provider Business Mailing Address
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Address Line | 4444 LANKERSHIM BLVD STE 104
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City | TOLUCA LAKE
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State | CA
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Zip | 91602-2346
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Country | US
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Telephone | 818-509-9233
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Fax | 818-301-0333
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Authorized Official
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Title or Position | OFFICER
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Name | NICOLE BRADSHAW
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Credential | L.AC.
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Telephone | 818-509-9233
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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 | AC8406
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License Number State | CA
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