Provider Demographics
NPI:1720807258
Name:INSTITUTE OF ACUPUNCTURE AND LIFESTYLE MEDICINE, INC
Entity type:Organization
Organization Name:INSTITUTE OF ACUPUNCTURE AND LIFESTYLE MEDICINE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NILOOFAR
Authorized Official - Middle Name:
Authorized Official - Last Name:NIKPOUR
Authorized Official - Suffix:
Authorized Official - Credentials:LAC, MTOM
Authorized Official - Phone:949-229-5055
Mailing Address - Street 1:31961 VIA GALLO
Mailing Address - Street 2:
Mailing Address - City:TRABUCO CANYON
Mailing Address - State:CA
Mailing Address - Zip Code:92679-3935
Mailing Address - Country:US
Mailing Address - Phone:310-863-5484
Mailing Address - Fax:714-362-2337
Practice Address - Street 1:30131 TOWN CENTER DR STE 270
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-2082
Practice Address - Country:US
Practice Address - Phone:949-229-5055
Practice Address - Fax:714-362-2337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-10
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty