Provider Demographics
NPI:1831663830
Name:HEALING ROOTS COMMUNITY ACUPUNCTURE
Entity Type:Organization
Organization Name:HEALING ROOTS COMMUNITY ACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, LICENSED ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:ALYSSA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HOUSER
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:657-900-2211
Mailing Address - Street 1:17541 IRVINE BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3158
Mailing Address - Country:US
Mailing Address - Phone:657-900-2211
Mailing Address - Fax:
Practice Address - Street 1:17541 IRVINE BLVD STE D
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3158
Practice Address - Country:US
Practice Address - Phone:657-900-2211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-14
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
1538549712OtherNPI