Provider Demographics
NPI:1225373590
Name:MEDICAL AND HEALING ARTS, INC
Entity Type:Organization
Organization Name:MEDICAL AND HEALING ARTS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:BUCKHORN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-871-7118
Mailing Address - Street 1:515 E COMMONWEALTH AVE
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92832-2020
Mailing Address - Country:US
Mailing Address - Phone:714-871-7118
Mailing Address - Fax:714-871-3372
Practice Address - Street 1:515 E COMMONWEALTH AVE
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92832-2020
Practice Address - Country:US
Practice Address - Phone:714-871-7118
Practice Address - Fax:714-871-3372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-27
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG73630261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health