Provider Demographics
NPI:1063973584
Name:SANTA MONICA SUPERIOR ACUPUNCTURE CLINIC INC.
Entity type:Organization
Organization Name:SANTA MONICA SUPERIOR ACUPUNCTURE CLINIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PULFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-592-8911
Mailing Address - Street 1:1528 6TH ST STE 120
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401-2564
Mailing Address - Country:US
Mailing Address - Phone:310-592-8911
Mailing Address - Fax:
Practice Address - Street 1:1528 6TH ST STE 120
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-2564
Practice Address - Country:US
Practice Address - Phone:310-592-8911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-27
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty