Provider Demographics
NPI:1265826283
Name:COLBERT ACUPUNCTURE
Entity Type:Organization
Organization Name:COLBERT ACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:RAMONA
Authorized Official - Middle Name:G
Authorized Official - Last Name:COLBERT
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:424-331-5661
Mailing Address - Street 1:PO BOX 743
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:CA
Mailing Address - Zip Code:90294-0743
Mailing Address - Country:US
Mailing Address - Phone:424-248-8013
Mailing Address - Fax:
Practice Address - Street 1:8725 LA TIJERA BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-3906
Practice Address - Country:US
Practice Address - Phone:424-331-5661
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-27
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 16297171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty