Provider Demographics
NPI:1275062663
Name:MIRACLE ACUPUNCTURE WELLNESS CENTER
Entity Type:Organization
Organization Name:MIRACLE ACUPUNCTURE WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NEGIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSTAMKOLAEI
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:949-633-5844
Mailing Address - Street 1:25401 CABOT RD, STE #210
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653
Mailing Address - Country:US
Mailing Address - Phone:949-633-5844
Mailing Address - Fax:949-305-9799
Practice Address - Street 1:25401 CABOT RD, STE #210
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653
Practice Address - Country:US
Practice Address - Phone:949-633-5844
Practice Address - Fax:949-305-9799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-08
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty