Provider Demographics
NPI:1154579779
Name:ALTERNATIVE WELLNESS CENTER
Entity type:Organization
Organization Name:ALTERNATIVE WELLNESS CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:FU
Authorized Official - Suffix:
Authorized Official - Credentials:LAC, QME, PHD
Authorized Official - Phone:562-430-8889
Mailing Address - Street 1:3720 KATELLA AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-3102
Mailing Address - Country:US
Mailing Address - Phone:562-430-8889
Mailing Address - Fax:562-430-8518
Practice Address - Street 1:3720 KATELLA AVE
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-3102
Practice Address - Country:US
Practice Address - Phone:562-430-8889
Practice Address - Fax:562-430-8518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-08
Last Update Date:2009-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC7765171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty