Provider Demographics
NPI:1760934111
Name:GREENLIFE ACUPUNCTURE INC
Entity Type:Organization
Organization Name:GREENLIFE ACUPUNCTURE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:MO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-263-0333
Mailing Address - Street 1:2616 BEACON ST
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-3104
Mailing Address - Country:US
Mailing Address - Phone:714-312-5460
Mailing Address - Fax:714-312-5460
Practice Address - Street 1:520 N BROOKHURST ST STE 102
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-5207
Practice Address - Country:US
Practice Address - Phone:714-312-5460
Practice Address - Fax:714-312-5460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-02
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC11989171100000X, 171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty