Provider Demographics
NPI:1518334226
Name:NOVATO ACUPUNCTURE AND HERB CLINIC INC
Entity Type:Organization
Organization Name:NOVATO ACUPUNCTURE AND HERB CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:E
Authorized Official - Last Name:PERI
Authorized Official - Suffix:
Authorized Official - Credentials:DOM
Authorized Official - Phone:415-897-4678
Mailing Address - Street 1:1531 S NOVATO BLVD
Mailing Address - Street 2:SUITE E
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94947-4184
Mailing Address - Country:US
Mailing Address - Phone:415-897-4678
Mailing Address - Fax:415-897-8558
Practice Address - Street 1:1531 S NOVATO BLVD
Practice Address - Street 2:SUITE E
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94947-4184
Practice Address - Country:US
Practice Address - Phone:415-897-4678
Practice Address - Fax:415-897-8558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-28
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5915171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty