Provider Demographics
NPI:1942800826
Name:ANCIENT HEALING WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:ANCIENT HEALING WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:GOMEZ-MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:MSOM, PHD
Authorized Official - Phone:210-663-4643
Mailing Address - Street 1:103 N PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78204-2430
Mailing Address - Country:US
Mailing Address - Phone:210-663-4643
Mailing Address - Fax:210-874-6617
Practice Address - Street 1:103 N PARK BLVD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78204-2430
Practice Address - Country:US
Practice Address - Phone:210-663-4643
Practice Address - Fax:210-874-6617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty