Provider Demographics
NPI:1568167039
Name:ACUPUNCTURE INTEGRATIVE MEDICINE
Entity Type:Organization
Organization Name:ACUPUNCTURE INTEGRATIVE MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:MS
Authorized Official - First Name:SHOHREH
Authorized Official - Middle Name:
Authorized Official - Last Name:OMIDI
Authorized Official - Suffix:
Authorized Official - Credentials:DAOM
Authorized Official - Phone:714-514-4639
Mailing Address - Street 1:24422 AVENIDA DE LA CARLOTA
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-3636
Mailing Address - Country:US
Mailing Address - Phone:949-561-2761
Mailing Address - Fax:949-446-8766
Practice Address - Street 1:24422 AVENIDA DE LA CARLOTA STE 105
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-3434
Practice Address - Country:US
Practice Address - Phone:949-561-2761
Practice Address - Fax:949-446-8766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty