Provider Demographics
NPI:1700153467
Name:COSMETIC ACUPUNCTURE CENTER, INC.
Entity type:Organization
Organization Name:COSMETIC ACUPUNCTURE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:F
Authorized Official - Last Name:GARCIA SOTO
Authorized Official - Suffix:
Authorized Official - Credentials:MSC ACUPUNCTURE
Authorized Official - Phone:909-464-8586
Mailing Address - Street 1:12598 CENTRAL AVE STE 107
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-3500
Mailing Address - Country:US
Mailing Address - Phone:909-464-8586
Mailing Address - Fax:626-646-1927
Practice Address - Street 1:12598 CENTRAL AVE STE 107
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-3500
Practice Address - Country:US
Practice Address - Phone:909-464-8586
Practice Address - Fax:626-646-1927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-23
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC13590171100000X
CAAC14318171100000X
CAAC13538171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty