=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851796528
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CRYSTEN SUMMER CLOUD M.A. L. AC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/23/2014
-----------------------------------------------------
Last Update Date | 10/23/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7931 SANTA MONICA BLVD
-----------------------------------------------------
City | WEST HOLLYWOOD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90046-5107
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-625-5798
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7931 SANTA MONICA BLVD
-----------------------------------------------------
City | WEST HOLLYWOOD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90046-5107
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-625-5798
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | 16168
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------