Provider Demographics
NPI:1720656861
Name:FORGET ME NOT ACUPUNCTURE AND HERBS, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:FORGET ME NOT ACUPUNCTURE AND HERBS, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SIMONE
Authorized Official - Middle Name:CLAUDIA
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:LAC, DTCM
Authorized Official - Phone:650-283-6524
Mailing Address - Street 1:765 SAN ANTONIO RD APT 63
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94303-4818
Mailing Address - Country:US
Mailing Address - Phone:650-283-6524
Mailing Address - Fax:
Practice Address - Street 1:765 SAN ANTONIO RD APT 63
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94303-4818
Practice Address - Country:US
Practice Address - Phone:650-283-6524
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-15
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty