Provider Demographics
NPI:1932772449
Name:EAST 2 WEST ACUPUNCTURE & MASSAGE LLC
Entity Type:Organization
Organization Name:EAST 2 WEST ACUPUNCTURE & MASSAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:
Authorized Official - Last Name:PROVENCIO
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:808-364-1555
Mailing Address - Street 1:94-673 KUPUOHI ST STE A204
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-5369
Mailing Address - Country:US
Mailing Address - Phone:808-364-1555
Mailing Address - Fax:
Practice Address - Street 1:94-673 KUPUOHI ST STE A204
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-5369
Practice Address - Country:US
Practice Address - Phone:808-364-1555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-22
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center