Provider Demographics
NPI: | 1164977658 |
---|---|
Name: | HUSAMI INTEGRATIVE ACUPUNCTURE |
Entity Type: | Organization |
Organization Name: | HUSAMI INTEGRATIVE ACUPUNCTURE |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | ACUPUNCTURIST |
Authorized Official - Prefix: | |
Authorized Official - First Name: | SUZANNE |
Authorized Official - Middle Name: | C |
Authorized Official - Last Name: | HUSAMI |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 619-302-7589 |
Mailing Address - Street 1: | 2555 CAMINO DEL RIO S |
Mailing Address - Street 2: | SUITE 102 |
Mailing Address - City: | SAN DIEGO |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 92108-3704 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 2555 CAMINO DEL RIO S |
Practice Address - Street 2: | SUITE 102 |
Practice Address - City: | SAN DIEGO |
Practice Address - State: | CA |
Practice Address - Zip Code: | 92108-3704 |
Practice Address - Country: | US |
Practice Address - Phone: | 619-302-7589 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2016-08-24 |
Last Update Date: | 2016-08-24 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CA | AC 15597 | 171100000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 171100000X | Other Service Providers | Acupuncturist | Group - Single Specialty |