Provider Demographics
NPI:1598021354
Name:ALTOS MEDICAL ACUPUNCTURE
Entity Type:Organization
Organization Name:ALTOS MEDICAL ACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, LICENSED ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:ANN MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEAS
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:650-949-4325
Mailing Address - Street 1:1000 FREMONT AVE
Mailing Address - Street 2:SUITE 152
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94024-6093
Mailing Address - Country:US
Mailing Address - Phone:650-949-4325
Mailing Address - Fax:650-949-4325
Practice Address - Street 1:1000 FREMONT AVE
Practice Address - Street 2:SUITE 152
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94024-6093
Practice Address - Country:US
Practice Address - Phone:650-949-4325
Practice Address - Fax:650-949-4325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-05
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13442171100000X
CA14335171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty