Provider Demographics
NPI:1013795913
Name:ROTHWEILER, HEIDE (DTCM, L AC)
Entity type:Individual
Prefix:
First Name:HEIDE
Middle Name:
Last Name:ROTHWEILER
Suffix:
Gender:F
Credentials:DTCM, L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1645 OLD BAYSHORE HWY
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-4305
Mailing Address - Country:US
Mailing Address - Phone:831-430-6186
Mailing Address - Fax:
Practice Address - Street 1:1645 OLD BAYSHORE HWY
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-4305
Practice Address - Country:US
Practice Address - Phone:831-430-6186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-20
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19844171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist