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General NPI Number Information
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NPI Number | 1912201617
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Entity Type | Organization
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Legal Business Name | LIBERTE ACUPUNCTURE, P.C.
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Dates
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Enumeration Date | 01/10/2011
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Last Update Date | 02/15/2013
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Provider Practice Location Address
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Address Line | 1221 CONNECTICUT AVE NW STE 5B
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City | WASHINGTON
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State | DC
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Zip | 20036-2607
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Country | US
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Telephone | 202-300-8428
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Fax |
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Provider Business Mailing Address
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Address Line | 1221 CONNECTICUT AVE NW STE 5B
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City | WASHINGTON
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State | DC
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Zip | 20036-2607
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Country | US
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Telephone | 202-300-8428
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Fax |
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Authorized Official
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Title or Position | ACUPUNCTURIST/PRESIDENT
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Name | MR. JOSELO GUTIERREZ
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Credential | LAC
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Telephone | 202-300-8428
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 004047
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | AC500151
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License Number State | DC
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