Provider Demographics
NPI:1770165011
Name:MOONSHADOW ACUPUNCTURE A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:MOONSHADOW ACUPUNCTURE A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RAYNA
Authorized Official - Middle Name:LEONORA
Authorized Official - Last Name:SAVROSA
Authorized Official - Suffix:
Authorized Official - Credentials:LAC, DACM
Authorized Official - Phone:415-429-1567
Mailing Address - Street 1:3900 IRVING ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94122-1217
Mailing Address - Country:US
Mailing Address - Phone:415-429-1567
Mailing Address - Fax:
Practice Address - Street 1:3900 IRVING ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94122-1217
Practice Address - Country:US
Practice Address - Phone:415-429-1567
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-26
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty