Provider Demographics
NPI:1992350672
Name:PATH OF WELLNESS HEALING ARTS LLC
Entity type:Organization
Organization Name:PATH OF WELLNESS HEALING ARTS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BERRIOS
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:480-712-7032
Mailing Address - Street 1:2034 S ALMA SCHOOL RD STE 4
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-4004
Mailing Address - Country:US
Mailing Address - Phone:480-712-7032
Mailing Address - Fax:
Practice Address - Street 1:2034 S ALMA SCHOOL RD STE 4
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-4004
Practice Address - Country:US
Practice Address - Phone:480-712-7032
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-08
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty