Provider Demographics
NPI:1922636646
Name:THE LUMA CENTER ACUPUNCTURE & WELLNESS, INC.
Entity Type:Organization
Organization Name:THE LUMA CENTER ACUPUNCTURE & WELLNESS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/ ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:FUGO ZIBELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:415-295-6108
Mailing Address - Street 1:616 PETALUMA BLVD N STE B
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-2847
Mailing Address - Country:US
Mailing Address - Phone:415-295-6108
Mailing Address - Fax:415-226-0570
Practice Address - Street 1:616 PETALUMA BLVD N STE B
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-2847
Practice Address - Country:US
Practice Address - Phone:415-295-6108
Practice Address - Fax:415-226-0570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-29
Last Update Date:2020-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty