Provider Demographics
NPI:1790198075
Name:DINA FIDEL ACUPUNCTURE INC
Entity Type:Organization
Organization Name:DINA FIDEL ACUPUNCTURE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DINA
Authorized Official - Middle Name:
Authorized Official - Last Name:FIDEL
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:408-481-4763
Mailing Address - Street 1:167 E FREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087-2501
Mailing Address - Country:US
Mailing Address - Phone:408-481-4763
Mailing Address - Fax:
Practice Address - Street 1:167 E FREMONT AVE
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-2501
Practice Address - Country:US
Practice Address - Phone:408-481-4763
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-04
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC7658261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1821206038OtherINDIVIDUAL NPI