Provider Demographics
NPI:1780939686
Name:ACUPUNCTURE & ALTERNATIVE MEDICINE OF ARIZONA
Entity type:Organization
Organization Name:ACUPUNCTURE & ALTERNATIVE MEDICINE OF ARIZONA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARINO
Authorized Official - Suffix:
Authorized Official - Credentials:L AC
Authorized Official - Phone:623-362-1434
Mailing Address - Street 1:3804 N 162ND LN
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-8075
Mailing Address - Country:US
Mailing Address - Phone:623-362-1434
Mailing Address - Fax:
Practice Address - Street 1:3804 N 162ND LN
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-8075
Practice Address - Country:US
Practice Address - Phone:623-362-1434
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-17
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0737171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty