Provider Demographics
NPI:1275837841
Name:GREEN HEALTH ACUPUNCTURE
Entity Type:Organization
Organization Name:GREEN HEALTH ACUPUNCTURE
Other - Org Name:IMED
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LICENSED ACUPUNCTURIST & HERBALIST
Authorized Official - Prefix:
Authorized Official - First Name:OLESIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FARBEROV
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:310-831-2202
Mailing Address - Street 1:150 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90731-3300
Mailing Address - Country:US
Mailing Address - Phone:310-831-2202
Mailing Address - Fax:
Practice Address - Street 1:150 W 6TH ST
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731-3300
Practice Address - Country:US
Practice Address - Phone:310-831-2202
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-22
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC10112171100000X
CA2431208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty