Provider Demographics
NPI:1770809576
Name:EILEEN HENRY ACUPUNCTURE, PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:EILEEN HENRY ACUPUNCTURE, PROFESSIONAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:310-826-8606
Mailing Address - Street 1:11611 SAN VICENTE BLVD STE 540
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-6509
Mailing Address - Country:US
Mailing Address - Phone:310-826-8606
Mailing Address - Fax:310-634-1891
Practice Address - Street 1:11611 SAN VICENTE BLVD STE 540
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-6509
Practice Address - Country:US
Practice Address - Phone:310-826-8606
Practice Address - Fax:310-634-1891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-19
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 4092171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty