Provider Demographics
NPI:1598119067
Name:ACUPUNCTURE AND HERBAL HOLISTIC CARE
Entity Type:Organization
Organization Name:ACUPUNCTURE AND HERBAL HOLISTIC CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SEPIDEH
Authorized Official - Middle Name:
Authorized Official - Last Name:LACKPOUR
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LAC
Authorized Official - Phone:310-749-6971
Mailing Address - Street 1:827 DEEP VALLEY DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ROLLING HILLS ESTATES
Mailing Address - State:CA
Mailing Address - Zip Code:90274-3692
Mailing Address - Country:US
Mailing Address - Phone:310-749-6971
Mailing Address - Fax:
Practice Address - Street 1:827 DEEP VALLEY DR
Practice Address - Street 2:SUITE 103
Practice Address - City:ROLLING HILLS ESTATES
Practice Address - State:CA
Practice Address - Zip Code:90274-3692
Practice Address - Country:US
Practice Address - Phone:310-749-6971
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-20
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC5194171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1699846956OtherPERSONAL NPI