MEDICARE: CORAZON HEALING ARTS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist

General Provider Information

NPI Number	:	1609275700
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORAZON HEALING ARTS

Provider Business Mailing Address
First Line	:	918 S ROBERTSON BLVD
Second Line	:	SUITE 3
City	:	LOS ANGELES
State	:	CA
Zip	:	90035-1611
Country	:	US
Telephone Number	:	310-699-2104
Fax Number	:

Provider Business Practice Location Address
First Line	:	918 S ROBERTSON BLVD
Second Line	:	SUITE 3
City	:	LOS ANGELES
State	:	CA
Zip	:	90035-1611
Country	:	US
Telephone Number	:	310-699-2104
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DAVID JONATHON WATTS
Credential	:	L.AC.
Telephone Number	:	310-699-2104

Provider Enumeration Date	:	08/14/2014
Last Update Date	:	08/14/2014

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Directions to “CORAZON HEALING ARTS ” Practice Location

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