Provider Demographics
NPI:1366471112
Name:ALBERTSON ACUPUNCTURE & HERBAL CARE, INC
Entity Type:Organization
Organization Name:ALBERTSON ACUPUNCTURE & HERBAL CARE, INC
Other - Org Name:OC ACUPUNCTURE, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ALBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:949-887-3527
Mailing Address - Street 1:51 SAN RAPHAEL
Mailing Address - Street 2:
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-4043
Mailing Address - Country:US
Mailing Address - Phone:949-887-3527
Mailing Address - Fax:949-861-8971
Practice Address - Street 1:24672 SAN JUAN AVE/
Practice Address - Street 2:STE # 104
Practice Address - City:DANA POINT
Practice Address - State:CA
Practice Address - Zip Code:92629-4043
Practice Address - Country:US
Practice Address - Phone:949-887-3527
Practice Address - Fax:949-861-8971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC5150171100000X
CA171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC 5150OtherCA ACUPUNCTURE LICENSE #