1881658656 NPI number — SACRED MOUNTAIN ACUPUNCTURE CL

Table of content: (NPI 1881658656)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881658656 NPI number — SACRED MOUNTAIN ACUPUNCTURE CL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SACRED MOUNTAIN ACUPUNCTURE CL
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:
1881658656
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/05/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
611 S. PALM CANYON DRIVE
Provider Second Line Business Mailing Address:
SUITE 7-574
Provider Business Mailing Address City Name:
PALM SPRINGS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92264-7453
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-327-3500
Provider Business Mailing Address Fax Number:
760-406-5860

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2150 EAST TAHQUITZ CANYON WAY
Provider Second Line Business Practice Location Address:
SUITE 5
Provider Business Practice Location Address City Name:
PALM SPRINGS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92262-6817
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-327-3500
Provider Business Practice Location Address Fax Number:
760-406-5860
Provider Enumeration Date:
04/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PERDUE
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
B
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
760-327-3500

Provider Taxonomy Codes

  • Taxonomy code: 171100000X , with the licence number:  AC8934 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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