Provider Demographics
NPI:1144390550
Name:PERSIMMON, A CENTER FOR HEALING ACUPUNCTURE CORPORATION
Entity Type:Organization
Organization Name:PERSIMMON, A CENTER FOR HEALING ACUPUNCTURE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:ESTHER
Authorized Official - Last Name:SCHLESINGER
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:707-823-8903
Mailing Address - Street 1:820 GRAVENSTEIN AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-4557
Mailing Address - Country:US
Mailing Address - Phone:707-823-8903
Mailing Address - Fax:707-676-8688
Practice Address - Street 1:820 GRAVENSTEIN AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-4557
Practice Address - Country:US
Practice Address - Phone:707-823-8903
Practice Address - Fax:707-676-8688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 7634171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty