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General NPI Number Information
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NPI Number | 1750552568
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Entity Type | Individual
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Provider Name | SHIZUE HAYASHI ITO L.AC.
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Gender | Female
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Dates
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Enumeration Date | 03/19/2008
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Last Update Date | 02/16/2018
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Provider Practice Location Address
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Address Line | 2960 HABOR BLVD., SUITE A & B
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City | COSTA MESA
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State | CA
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Zip | 92626
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Country | US
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Telephone | 949-648-2788
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Fax | 949-726-1638
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Provider Business Mailing Address
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Address Line | 2960 HARBOR BLVD., SUITES A & B
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City | COSTA MESA
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State | CA
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Zip | 92626
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Country | US
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Telephone | 949-648-2788
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Fax | 949-726-1638
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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 | AC7144
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License Number State | CA
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