Provider Demographics
NPI:1649833179
Name:KUMO ACUPUNCTURE AND ORIENTAL MEDICINE
Entity type:Organization
Organization Name:KUMO ACUPUNCTURE AND ORIENTAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:MASFERRER
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:503-318-9490
Mailing Address - Street 1:214 E BIRCH ST STE 4
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-3043
Mailing Address - Country:US
Mailing Address - Phone:503-318-9490
Mailing Address - Fax:509-209-9094
Practice Address - Street 1:214 E BIRCH ST STE 4
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-3043
Practice Address - Country:US
Practice Address - Phone:503-318-9490
Practice Address - Fax:509-209-9094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-19
Last Update Date:2019-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service