Provider Demographics
NPI:1790292993
Name:ANTOUN ACUPUNCTURE
Entity Type:Organization
Organization Name:ANTOUN ACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:ANTOUN
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:818-326-2216
Mailing Address - Street 1:13301 MISSION TIERRA WAY
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-1127
Mailing Address - Country:US
Mailing Address - Phone:818-326-2216
Mailing Address - Fax:
Practice Address - Street 1:19231 VICTORY BLVD STE 150
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-6315
Practice Address - Country:US
Practice Address - Phone:818-492-9383
Practice Address - Fax:818-342-6202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-09
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15991171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA568738275OtherSS