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General NPI Number Information
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NPI Number | 1760934111
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Entity Type | Organization
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Legal Business Name | GREENLIFE ACUPUNCTURE INC
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Dates
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Enumeration Date | 11/02/2016
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Last Update Date | 03/10/2020
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Provider Practice Location Address
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Address Line | 520 N BROOKHURST ST STE 102
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City | ANAHEIM
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State | CA
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Zip | 92801-5207
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Country | US
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Telephone | 714-312-5460
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Fax | 714-312-5460
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Provider Business Mailing Address
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Address Line | 2616 BEACON ST
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City | FULLERTON
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State | CA
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Zip | 92835-3104
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Country | US
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Telephone | 714-312-5460
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Fax | 714-312-5460
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Authorized Official
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Title or Position | MANAGER
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Name | ANDY MO
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Credential |
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Telephone | 909-263-0333
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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 | AC11989
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License Number State | CA
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