Provider Demographics
NPI:1346424322
Name:DEBELE, WENDELL PAUL (L AC)
Entity Type:Individual
Prefix:
First Name:WENDELL
Middle Name:PAUL
Last Name:DEBELE
Suffix:
Gender:M
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4245 MOUNT TAYLOR DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-6219
Mailing Address - Country:US
Mailing Address - Phone:415-260-7848
Mailing Address - Fax:
Practice Address - Street 1:4245 MOUNT TAYLOR DR
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-6219
Practice Address - Country:US
Practice Address - Phone:415-260-7848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-26
Last Update Date:2007-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 5576171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist