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General NPI Number Information
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NPI Number | 1770833840
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Entity Type | Organization
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Legal Business Name | JOHN CAMESA LAC A PROFESSIONAL ACUP CORP
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Dates
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Enumeration Date | 09/14/2012
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Last Update Date | 09/14/2012
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Provider Practice Location Address
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Address Line | 17150 EUCLID ST STE 316
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-4092
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Country | US
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Telephone | 949-350-2898
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Fax |
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Provider Business Mailing Address
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Address Line | 707 S WEBSTER AVE #117
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City | ANAHEIM
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State | CA
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Zip | 92804-7324
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Country | US
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Telephone | 949-350-2898
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOHN CAMESA
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Credential | LAC
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Telephone | 949-350-2898
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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 | AC9257
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License Number State | CA
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