Provider Demographics
NPI:1639550247
Name:HOLISTIC SPORTS ACUPUNCTURE
Entity Type:Organization
Organization Name:HOLISTIC SPORTS ACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:MELANI
Authorized Official - Middle Name:
Authorized Official - Last Name:LEONARD-COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:323-710-6751
Mailing Address - Street 1:1627 N POINSETTIA PL
Mailing Address - Street 2:APT.17
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90046-3566
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1000 E DOMINGUEZ ST
Practice Address - Street 2:SUITE 101
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90746-3600
Practice Address - Country:US
Practice Address - Phone:310-327-1325
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-10
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 14368171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty