Provider Demographics
NPI:1790146082
Name:AMADOR VALLEY WELLNESS INC
Entity Type:Organization
Organization Name:AMADOR VALLEY WELLNESS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:AHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-829-9000
Mailing Address - Street 1:7660 AMADOR VALLEY BLVD
Mailing Address - Street 2:SUITE D-1
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-2314
Mailing Address - Country:US
Mailing Address - Phone:925-829-9000
Mailing Address - Fax:
Practice Address - Street 1:7660 AMADOR VALLEY BLVD
Practice Address - Street 2:SUITE D-1
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568-2314
Practice Address - Country:US
Practice Address - Phone:925-829-9000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-14
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty