Provider Demographics
NPI:1780419929
Name:WILDFLOWER ACUPUNCTURE INC.
Entity type:Organization
Organization Name:WILDFLOWER ACUPUNCTURE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, DOCTOR OF ACUPUNCTURE
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:MANN
Authorized Official - Suffix:
Authorized Official - Credentials:LACCHM
Authorized Official - Phone:818-333-6324
Mailing Address - Street 1:4404 W RIVERSIDE DR STE A
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-4046
Mailing Address - Country:US
Mailing Address - Phone:818-333-6324
Mailing Address - Fax:
Practice Address - Street 1:4404 W RIVERSIDE DR STE A
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4046
Practice Address - Country:US
Practice Address - Phone:818-333-6324
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-06
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1437856085Medicaid