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General NPI Number Information
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NPI Number | 1689941304
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Entity Type | Individual
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Provider Name | MIA PURIFICACION LAHOZ BS, MSAOM, LAC
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Gender | Female
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Dates
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Enumeration Date | 11/23/2011
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Last Update Date | 11/23/2011
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Provider Practice Location Address
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Address Line | 2131 S ARCHER AVE # BANDC
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City | CHICAGO
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State | IL
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Zip | 60616-1809
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Country | US
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Telephone | 312-842-2775
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Fax |
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Provider Business Mailing Address
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Address Line | 4214 N ASHLAND AVE
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City | CHICAGO
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State | IL
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Zip | 60613-1202
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Country | US
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Telephone | 773-749-0264
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 198.000861
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License Number State | IL
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