Provider Demographics
NPI:1811755762
Name:COVE ACUPUNCTURE & FUNCTIONAL MEDICINE INCORPORATED
Entity type:Organization
Organization Name:COVE ACUPUNCTURE & FUNCTIONAL MEDICINE INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDRA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:BRUEHL
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:323-470-4143
Mailing Address - Street 1:1411 N AVENUE 50
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90042-1719
Mailing Address - Country:US
Mailing Address - Phone:323-470-4143
Mailing Address - Fax:
Practice Address - Street 1:4306 MELROSE AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90029-3511
Practice Address - Country:US
Practice Address - Phone:323-484-4560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-06
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty