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General NPI Number Information
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NPI Number | 1790483873
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Entity Type | Organization
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Legal Business Name | MYLIFE ACUCENTER, INC.
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Dates
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Enumeration Date | 02/20/2023
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Last Update Date | 02/20/2023
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Provider Practice Location Address
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Address Line | 16486 BERNARDO CENTER DR STE 100
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City | SAN DIEGO
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State | CA
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Zip | 92128-2519
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Country | US
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Telephone | 626-765-5678
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Fax | 888-691-2206
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Provider Business Mailing Address
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Address Line | 11422 AUTUMN SAGE AVE
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City | JURUPA VALLEY
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State | CA
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Zip | 91752-5035
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Country | US
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Telephone | 909-979-4568
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Fax | 888-691-2206
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Authorized Official
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Title or Position | PHYSICIAN
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Name | GUANG DI CHANG
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Credential | L.AC.
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Telephone | 909-979-4568
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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 |
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License Number State |
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