Provider Demographics
NPI:1649582396
Name:GOLETA ACUPUNCTURE WELLNESS CLINIC
Entity type:Organization
Organization Name:GOLETA ACUPUNCTURE WELLNESS CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAIJING
Authorized Official - Middle Name:LIU
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:L AC
Authorized Official - Phone:805-895-5507
Mailing Address - Street 1:5266 HOLLISTER AVE
Mailing Address - Street 2:SUITE 215
Mailing Address - City:SANTA BARBARA,
Mailing Address - State:CA
Mailing Address - Zip Code:93111
Mailing Address - Country:US
Mailing Address - Phone:805-895-5507
Mailing Address - Fax:895-967-7400
Practice Address - Street 1:5266 HOLLISTER AVE
Practice Address - Street 2:SUITE 215
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93111-2037
Practice Address - Country:US
Practice Address - Phone:805-895-5507
Practice Address - Fax:895-967-7400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-10
Last Update Date:2010-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC12399171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty