Provider Demographics
NPI:1194361881
Name:DISALVO YU TCM ACUPUNCTURE FAMILY PC
Entity Type:Organization
Organization Name:DISALVO YU TCM ACUPUNCTURE FAMILY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:DISALVO
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:818-650-8555
Mailing Address - Street 1:17203 VENTURA BLVD STE 2
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-4054
Mailing Address - Country:US
Mailing Address - Phone:818-650-8555
Mailing Address - Fax:
Practice Address - Street 1:17203 VENTURA BLVD STE 2
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-4054
Practice Address - Country:US
Practice Address - Phone:818-650-8555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-18
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty