Provider Demographics
NPI:1720229487
Name:WESTSIDE ACUPUNCTURE & WELLNESS CENTER, INC
Entity Type:Organization
Organization Name:WESTSIDE ACUPUNCTURE & WELLNESS CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRANDA
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:310-914-1624
Mailing Address - Street 1:11850 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-6609
Mailing Address - Country:US
Mailing Address - Phone:310-914-1624
Mailing Address - Fax:310-696-2400
Practice Address - Street 1:11850 WILSHIRE BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-6609
Practice Address - Country:US
Practice Address - Phone:310-914-1624
Practice Address - Fax:310-696-2400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-10
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5165261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty