Provider Demographics
NPI:1659817419
Name:ACUPUNCTURE HERBAL CENTER
Entity Type:Organization
Organization Name:ACUPUNCTURE HERBAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEIRDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:CLAIBORNE
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:415-485-5834
Mailing Address - Street 1:824 5TH AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-3257
Mailing Address - Country:US
Mailing Address - Phone:415-485-5834
Mailing Address - Fax:415-456-2636
Practice Address - Street 1:824 5TH AVE
Practice Address - Street 2:SUITE C
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-3257
Practice Address - Country:US
Practice Address - Phone:415-485-5834
Practice Address - Fax:415-456-2636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-17
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC1488171100000X
CAAC1592171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty