Provider Demographics
NPI:1407248891
Name:MAGNOLIA ACUPUNCTURE, INC.
Entity Type:Organization
Organization Name:MAGNOLIA ACUPUNCTURE, INC.
Other - Org Name:URBAN TREE ACUPUNCTURE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ACUPUNCTURIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PHILIP
Authorized Official - Last Name:O'HARA
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:714-248-7871
Mailing Address - Street 1:8262 ATLANTA AVE
Mailing Address - Street 2:22
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92646-6116
Mailing Address - Country:US
Mailing Address - Phone:310-977-4019
Mailing Address - Fax:
Practice Address - Street 1:14501 MAGNOLIA ST
Practice Address - Street 2:103
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-1306
Practice Address - Country:US
Practice Address - Phone:714-248-7871
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-23
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15485171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty