Provider Demographics
NPI:1821206038
Name:FIDEL, DINA (L AC)
Entity Type:Individual
Prefix:
First Name:DINA
Middle Name:
Last Name:FIDEL
Suffix:
Gender:F
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3734 FARM HILL BLVD
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94061-1810
Mailing Address - Country:US
Mailing Address - Phone:650-346-7027
Mailing Address - Fax:408-481-4764
Practice Address - Street 1:3734 FARM HILL BLVD
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94061-1810
Practice Address - Country:US
Practice Address - Phone:650-346-7027
Practice Address - Fax:408-481-4764
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-19
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC7658171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist