Individual
ANTONIO PROVENCIO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LAC
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
—
CA
171100000X
Acupuncturist
Primary
—
HI
225700000X
Massage Therapist
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1231
ACUPUNCTURE STATE LICENSE
HI
01
—
17178
ACUPUNCTURE STATE LICENSE
CA
01
—
1740780949
NPI FOR EAST 2 WEST INTEGRATIVE MEDICINE
—
Enumeration date
02/17/2018
Last updated
07/29/2018
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
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