Provider Demographics
NPI:1447547542
Name:ACUPUNCTURE STUDIO OF SAN RAFAEL
Entity type:Organization
Organization Name:ACUPUNCTURE STUDIO OF SAN RAFAEL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST, CO FOUNDER
Authorized Official - Prefix:MISS
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:
Authorized Official - Last Name:SCRIVEN
Authorized Official - Suffix:
Authorized Official - Credentials:MS LAC
Authorized Official - Phone:415-488-3932
Mailing Address - Street 1:8 GRANDE PASEO
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-1518
Mailing Address - Country:US
Mailing Address - Phone:415-328-6098
Mailing Address - Fax:
Practice Address - Street 1:526 3RD ST STE C1
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-3364
Practice Address - Country:US
Practice Address - Phone:415-488-3932
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-09
Last Update Date:2011-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC13882171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty