Provider Demographics
NPI:1073917530
Name:MENLA ACUPUNCTURE AND ORIENTAL MEDICINE PLLC
Entity Type:Organization
Organization Name:MENLA ACUPUNCTURE AND ORIENTAL MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/ ACUPUNCTURIST
Authorized Official - Prefix:MS
Authorized Official - First Name:DANIELA
Authorized Official - Middle Name:CHRIST
Authorized Official - Last Name:VAN WART
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:520-308-0071
Mailing Address - Street 1:1827 PASEO SAN LUIS
Mailing Address - Street 2:STE B
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-4630
Mailing Address - Country:US
Mailing Address - Phone:520-803-0071
Mailing Address - Fax:
Practice Address - Street 1:1827 PASEO SAN LUIS
Practice Address - Street 2:STE B
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-4630
Practice Address - Country:US
Practice Address - Phone:520-803-0071
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-13
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ931171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty