=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699278614
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INFINITE SKY ACUPUNCTURE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/15/2018
-----------------------------------------------------
Last Update Date | 09/24/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 760 N WOODROSE PL
-----------------------------------------------------
City | TUCSON
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85710-3191
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-886-4089
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 760 N WOODROSE PL
-----------------------------------------------------
City | TUCSON
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85710-3191
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-886-4089
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MS. SONYA K WHITEHEAD
-----------------------------------------------------
Credential | LAC
-----------------------------------------------------
Telephone | 520-886-4089
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | 1073
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------