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General NPI Number Information
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NPI Number | 1790084531
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Entity Type | Individual
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Provider Name | MICHAEL ROBERT NISS L.AC.
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Gender | Male
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Dates
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Enumeration Date | 03/18/2011
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Last Update Date | 03/18/2011
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Provider Practice Location Address
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Address Line | 4209 SANTA MONICA BLVD STE 100
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City | LOS ANGELES
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State | CA
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Zip | 90029-3027
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Country | US
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Telephone | 323-617-5027
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Fax | 323-617-5027
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Provider Business Mailing Address
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Address Line | 4209 SANTA MONICA BLVD STE 100
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City | LOS ANGELES
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State | CA
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Zip | 90029-3027
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Country | US
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Telephone | 323-617-5027
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Fax | 323-617-5027
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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 | AC 13957
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License Number State | CA
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