Provider Demographics
NPI:1427432533
Name:PATTY JOHNSON'S ACUPUNCTURE AND HERBS
Entity type:Organization
Organization Name:PATTY JOHNSON'S ACUPUNCTURE AND HERBS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:PATTY
Authorized Official - Middle Name:JO
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:909-989-3223
Mailing Address - Street 1:8645 HAVEN AVE STE 550
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-4865
Mailing Address - Country:US
Mailing Address - Phone:909-989-3223
Mailing Address - Fax:909-989-4430
Practice Address - Street 1:8645 HAVEN AVE STE 550
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-4865
Practice Address - Country:US
Practice Address - Phone:909-989-3223
Practice Address - Fax:909-989-4430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-17
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 8096261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1030692OtherAMERICAN SPECIALTY HEALTH