Provider Demographics
NPI:1093306334
Name:PLUMERIA ACUPUNCTURE AND HOLISTIC WELLNESS CENTER, LLC
Entity Type:Organization
Organization Name:PLUMERIA ACUPUNCTURE AND HOLISTIC WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AYAKO
Authorized Official - Middle Name:
Authorized Official - Last Name:MIZUNO
Authorized Official - Suffix:
Authorized Official - Credentials:DAOM
Authorized Official - Phone:414-687-0087
Mailing Address - Street 1:2500 N MAYFAIR RD STE 410
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-1415
Mailing Address - Country:US
Mailing Address - Phone:414-687-0087
Mailing Address - Fax:
Practice Address - Street 1:2500 N MAYFAIR RD
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-1409
Practice Address - Country:US
Practice Address - Phone:414-687-0087
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-29
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1002-55OtherLICENSED ACUPUNCTURIST