Provider Demographics
NPI:1912201617
Name:LIBERTE ACUPUNCTURE, P.C.
Entity Type:Organization
Organization Name:LIBERTE ACUPUNCTURE, P.C.
Other - Org Name:CITY ACUPUNCTURE CIRCLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACUPUNCTURIST/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSELO
Authorized Official - Middle Name:
Authorized Official - Last Name:GUTIERREZ
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:202-300-8428
Mailing Address - Street 1:1221 CONNECTICUT AVE NW STE 5B
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20036-2607
Mailing Address - Country:US
Mailing Address - Phone:202-300-8428
Mailing Address - Fax:
Practice Address - Street 1:1221 CONNECTICUT AVE NW STE 5B
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-2607
Practice Address - Country:US
Practice Address - Phone:202-300-8428
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-10
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004047261QH0100X
DCAC500151261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service