Provider Demographics
NPI:1326674862
Name:BLEU SUNFLOWER ACUPUNCTURE AND WELLNESS
Entity Type:Organization
Organization Name:BLEU SUNFLOWER ACUPUNCTURE AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELLISA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ALVAREZ BENSON
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:424-392-4984
Mailing Address - Street 1:441 E CARSON ST STE J
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90745-7712
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:441 E CARSON ST STE J
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90745-7712
Practice Address - Country:US
Practice Address - Phone:424-392-4984
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-17
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center