=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891230165
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CELINA DE LA ROCHA HENLEY L.AC.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/22/2016
-----------------------------------------------------
Last Update Date | 12/22/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1417 W BEVERLY BLVD 102
-----------------------------------------------------
City | MONTEBELLO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90640-4123
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-528-7232
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2600 W LA HABRA BLVD APT. 132
-----------------------------------------------------
City | LA HABRA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90631-4349
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-528-7232
-----------------------------------------------------
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 | 17140
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------