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General NPI Number Information
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NPI Number | 1881658656
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Entity Type | Organization
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Legal Business Name | SACRED MOUNTAIN ACUPUNCTURE CL
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Dates
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Enumeration Date | 04/17/2006
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Last Update Date | 03/05/2009
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Provider Practice Location Address
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Address Line | 2150 EAST TAHQUITZ CANYON WAY SUITE 5
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City | PALM SPRINGS
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State | CA
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Zip | 92262-6817
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Country | US
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Telephone | 760-327-3500
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Fax | 760-406-5860
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Provider Business Mailing Address
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Address Line | 611 S. PALM CANYON DRIVE SUITE 7-574
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City | PALM SPRINGS
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State | CA
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Zip | 92264-7453
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Country | US
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Telephone | 760-327-3500
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Fax | 760-406-5860
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Authorized Official
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Title or Position | OWNER
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Name | MR. JAMES B PERDUE JR.
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Credential | L.AC
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Telephone | 760-327-3500
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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 | AC8934
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License Number State | CA
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