Provider Demographics
NPI:1740369172
Name:GARDEN OF WELLNESS ACUPUNCTURE
Entity type:Organization
Organization Name:GARDEN OF WELLNESS ACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:PETRA
Authorized Official - Middle Name:BEATRICE
Authorized Official - Last Name:MONCRIEF
Authorized Official - Suffix:
Authorized Official - Credentials:MTOM
Authorized Official - Phone:760-325-7776
Mailing Address - Street 1:1276 N PALM CANYON DR
Mailing Address - Street 2:SUITE 208
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-4411
Mailing Address - Country:US
Mailing Address - Phone:760-325-7776
Mailing Address - Fax:760-325-7715
Practice Address - Street 1:1276 N PALM CANYON DR
Practice Address - Street 2:SUITE 208
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-4411
Practice Address - Country:US
Practice Address - Phone:760-325-7776
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-05
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC8945171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1861447336OtherNPI
CAAC8945OtherSTATE LICENSE