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General NPI Number Information
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NPI Number | 1689125171
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Entity Type | Organization
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Legal Business Name | CITY ACUPUNCTURE
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Dates
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Enumeration Date | 10/19/2016
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Last Update Date | 10/19/2016
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Provider Practice Location Address
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Address Line | 300 S PARK AVE
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City | TUCSON
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State | AZ
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Zip | 85719-6130
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Country | US
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Telephone | 520-332-5509
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Fax |
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Provider Business Mailing Address
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Address Line | 3349 E PRESIDIO RD
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City | TUCSON
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State | AZ
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Zip | 85716-1633
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Country | US
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Telephone | 520-332-5509
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JENNIFER PROVIDENCE
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Credential | LAC
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Telephone | 520-332-5509
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number | 1046
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License Number State | AZ
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