Provider Demographics
NPI:1518301308
Name:RO, ASHLEY (AC)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:RO
Suffix:
Gender:F
Credentials:AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 S WINCHESTER BLVD STE D138
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-3914
Mailing Address - Country:US
Mailing Address - Phone:408-393-0157
Mailing Address - Fax:
Practice Address - Street 1:1101 S WINCHESTER BLVD STE D138
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128
Practice Address - Country:US
Practice Address - Phone:408-394-0288
Practice Address - Fax:408-217-8327
Is Sole Proprietor?:No
Enumeration Date:2013-04-23
Last Update Date:2018-12-05
Deactivation Date:2018-11-24
Deactivation Code:
Reactivation Date:2018-12-05
Provider Licenses
StateLicense IDTaxonomies
CAAC15197171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC15197OtherACUPUNCTURIST