Provider Demographics
NPI:1104297589
Name:EAST WEST WOMEN'S HEALTH CENTER, LLC
Entity type:Organization
Organization Name:EAST WEST WOMEN'S HEALTH CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAHLISE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOTA
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:575-495-2475
Mailing Address - Street 1:2800 FOLSOM ST
Mailing Address - Street 2:SUITE C @ THE BIRTH CENTER OF BOULDER
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-3738
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2800 FOLSOM ST
Practice Address - Street 2:SUITE C @ THE BIRTH CENTER OF BOULDER
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-3738
Practice Address - Country:US
Practice Address - Phone:575-495-2475
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-12
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1972171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty