Provider Demographics
NPI:1578012639
Name:ADVANCED ACUPUNCTURE & WELLNESS CENTER
Entity Type:Organization
Organization Name:ADVANCED ACUPUNCTURE & WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:H
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:PH D ,
Authorized Official - Phone:760-832-7585
Mailing Address - Street 1:40055 BOB HOPE DR STE H
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-3940
Mailing Address - Country:US
Mailing Address - Phone:760-832-7585
Mailing Address - Fax:
Practice Address - Street 1:40055 BOB HOPE DR STE H
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-3940
Practice Address - Country:US
Practice Address - Phone:760-832-7585
Practice Address - Fax:760-832-7172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-29
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC16316302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1205225539OtherACUPUNCTURE