Provider Demographics
NPI:1417477522
Name:LITTLE SAGE ACUPUNCTURE AND HERBAL MEDICINE, INC.
Entity Type:Organization
Organization Name:LITTLE SAGE ACUPUNCTURE AND HERBAL MEDICINE, INC.
Other - Org Name:LITTLE SAGE ACUPUNCTURE AND HERBAL MEDICINE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROXAS
Authorized Official - Suffix:
Authorized Official - Credentials:LAC, DIPLOM
Authorized Official - Phone:562-310-1948
Mailing Address - Street 1:PO BOX 16025
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-0525
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2800 PACIFIC AVE STE A
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-1468
Practice Address - Country:US
Practice Address - Phone:562-310-1948
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-21
Last Update Date:2017-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty