1619638251 NPI number — BARONA ACUPUNCTURE & HERB CLINIC

Table of content: MAY ANN VICENTE HUDGINS RPH (NPI 1255157780)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619638251 NPI number — BARONA ACUPUNCTURE & HERB CLINIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BARONA ACUPUNCTURE & HERB CLINIC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619638251
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/04/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12131 BERTHA ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CERRITOS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90703-7520
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
213-383-0007
Provider Business Mailing Address Fax Number:
866-621-2931

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3407 W 6TH ST STE 617
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90020-2553
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-383-0007
Provider Business Practice Location Address Fax Number:
866-621-2931
Provider Enumeration Date:
01/05/2022

Additional Information

Authorized Official

Authorized Official Last Name:
PARK
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
213-383-0007

Provider Taxonomy Codes

  • Taxonomy code: 171100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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