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? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 171100000X | Other Service Providers | Acupuncturist | Group - Single Specialty |