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General NPI Number Information
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NPI Number | 1972991925
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Entity Type | Organization
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Legal Business Name | BOOYAH CONSULTING INC
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Dates
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Enumeration Date | 12/29/2014
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Last Update Date | 01/05/2017
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Provider Practice Location Address
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Address Line | 4834 STERN AVE
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City | SHERMAN OAKS
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State | CA
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Zip | 91423-1924
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Country | US
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Telephone | 323-213-9220
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Fax |
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Provider Business Mailing Address
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Address Line | 4834 STERN AVE
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City | SHERMAN OAKS
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State | CA
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Zip | 91423-1924
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Country | US
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Telephone | 323-213-9220
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | CONOR ADAM LOGAN
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Credential | L.AC.
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Telephone | 323-213-9220
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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 | AC16258
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License Number State | CA
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