Provider Demographics
NPI:1003172941
Name:BRENDA B. SMITH, LICENSED ACUPUNCTURIST, INC.
Entity Type:Organization
Organization Name:BRENDA B. SMITH, LICENSED ACUPUNCTURIST, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:626-356-3220
Mailing Address - Street 1:99 S CHESTER AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-5805
Mailing Address - Country:US
Mailing Address - Phone:626-356-3220
Mailing Address - Fax:626-356-3222
Practice Address - Street 1:99 S CHESTER AVE STE 101
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-5805
Practice Address - Country:US
Practice Address - Phone:626-356-3220
Practice Address - Fax:626-356-3222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-04
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC7809171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty