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General NPI Number Information
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NPI Number | 1780973289
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Entity Type | Organization
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Legal Business Name | HEALING TREE MEDICAL MANAGEMENT, INC.
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Dates
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Enumeration Date | 04/05/2011
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Last Update Date | 09/21/2012
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Provider Practice Location Address
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Address Line | 14785 JEFFREY RD SUITE 109
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City | IRVINE
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State | CA
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Zip | 92618-0408
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Country | US
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Telephone | 714-743-4990
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Fax | 949-559-3631
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Provider Business Mailing Address
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Address Line | 14785 JEFFREY RD SUITE 109
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City | IRVINE
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State | CA
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Zip | 92618-0408
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Country | US
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Telephone | 714-743-4990
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Fax | 949-559-3631
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Authorized Official
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Title or Position | PRESIDENT/ACUPUNTURIST
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Name | SHANE LEE
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Credential | L.AC.
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Telephone | 714-743-4990
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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 | AC9915
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License Number State | CA
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