=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831859180
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REMEDY ACUPUNCTURE INJURY REJUVENATION AND PAIN MANAGEMENT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/28/2021
-----------------------------------------------------
Last Update Date | 01/24/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1007 E 900 S STE B
-----------------------------------------------------
City | SALT LAKE CITY
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84105-1468
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-734-1972
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2986 W LEHMAN AVE APT 326
-----------------------------------------------------
City | WEST VALLEY CITY
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84119-3621
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-734-1972
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ACUPUNCTURIST/OWNER
-----------------------------------------------------
Name | MR. ANDY H ALZAMORA
-----------------------------------------------------
Credential | L.AC.
-----------------------------------------------------
Telephone | 201-734-1972
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------