Provider Demographics
NPI:1720603988
Name:QUALITY LIFE ACUPUNCTURE & HEALTH CARE
Entity Type:Organization
Organization Name:QUALITY LIFE ACUPUNCTURE & HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LAC
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOCELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:WATANABE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-685-2680
Mailing Address - Street 1:1110 SUNNYVALE SARATOGA RD STE B2
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087-2554
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1110 SUNNYVALE SARATOGA RD STE B2
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-2554
Practice Address - Country:US
Practice Address - Phone:408-685-2680
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-13
Last Update Date:2020-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA073982OtherACUPUNCTURE