Provider Demographics
NPI:1083022206
Name:MULBERRY LEAF ACUPUNCTURE & HERBS
Entity Type:Organization
Organization Name:MULBERRY LEAF ACUPUNCTURE & HERBS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:ALEKSANDRA
Authorized Official - Middle Name:MONJE
Authorized Official - Last Name:DIANOVA
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:213-446-5428
Mailing Address - Street 1:18065 W TERRA VERDE PL
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91387-1830
Mailing Address - Country:US
Mailing Address - Phone:213-446-5428
Mailing Address - Fax:
Practice Address - Street 1:5257 VINELAND AVE
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91601
Practice Address - Country:US
Practice Address - Phone:213-446-5428
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-31
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15511171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty