Provider Demographics
NPI:1225534332
Name:GOSPEL LIGHT BIBLE CHURCH
Entity Type:Organization
Organization Name:GOSPEL LIGHT BIBLE CHURCH
Other - Org Name:GOSPEL LIGHT ACUPUNCTURE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WEI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-927-7712
Mailing Address - Street 1:1816 DESIRE AVE
Mailing Address - Street 2:
Mailing Address - City:ROWLAND HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91748-2917
Mailing Address - Country:US
Mailing Address - Phone:626-927-7712
Mailing Address - Fax:
Practice Address - Street 1:1816 DESIRE AVE
Practice Address - Street 2:
Practice Address - City:ROWLAND HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91748-2917
Practice Address - Country:US
Practice Address - Phone:626-927-7712
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-05
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty