Provider Demographics
NPI:1023552692
Name:FERNANDES ACUPUNCTURE AND CHINESE HERBAL MEDICINE, INC.
Entity Type:Organization
Organization Name:FERNANDES ACUPUNCTURE AND CHINESE HERBAL MEDICINE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:LISA
Authorized Official - Last Name:FERNANDES
Authorized Official - Suffix:
Authorized Official - Credentials:LIC AC, MAOM
Authorized Official - Phone:978-473-9393
Mailing Address - Street 1:277 MAIN ST
Mailing Address - Street 2:SUITE 208
Mailing Address - City:MARLBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01752-5508
Mailing Address - Country:US
Mailing Address - Phone:978-473-9393
Mailing Address - Fax:978-568-0767
Practice Address - Street 1:277 MAIN ST
Practice Address - Street 2:SUITE 208
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-5508
Practice Address - Country:US
Practice Address - Phone:978-473-9393
Practice Address - Fax:978-568-0767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-15
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA233902171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty