Provider Demographics
NPI:1356882971
Name:SAGE WELLNESS CENTER INC.
Entity type:Organization
Organization Name:SAGE WELLNESS CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YVETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:DELLANINI-WARD
Authorized Official - Suffix:
Authorized Official - Credentials:LAC,MS
Authorized Official - Phone:650-343-7899
Mailing Address - Street 1:601 S B ST
Mailing Address - Street 2:STE: A
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-4120
Mailing Address - Country:US
Mailing Address - Phone:650-343-7899
Mailing Address - Fax:650-458-9209
Practice Address - Street 1:601 S B ST
Practice Address - Street 2:STE: A
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-4120
Practice Address - Country:US
Practice Address - Phone:650-343-7899
Practice Address - Fax:650-458-9209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-15
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC7674171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty