Provider Demographics
NPI:1780454454
Name:ACOC1 LLC
Entity type:Organization
Organization Name:ACOC1 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALER
Authorized Official - Prefix:
Authorized Official - First Name:PARMIS
Authorized Official - Middle Name:
Authorized Official - Last Name:LJATOBO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-295-0414
Mailing Address - Street 1:29911 NIGUEL RD UNIT 6429
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92607-2417
Mailing Address - Country:US
Mailing Address - Phone:949-295-0414
Mailing Address - Fax:
Practice Address - Street 1:1307 W 6TH ST STE 105
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-1644
Practice Address - Country:US
Practice Address - Phone:888-873-6220
Practice Address - Fax:888-876-6220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-04
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty