Healthcare Provider Details

I. General information

NPI: 1144776519
Provider Name (Legal Business Name): ZYLLA ACUPUNCTURE PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2016
Last Update Date: 08/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3210 E FORT LOWELL RD SUITE 103
TUCSON AZ
85716-1682
US

IV. Provider business mailing address

3210 E FORT LOWELL RD SUITE 103
TUCSON AZ
85716-1682
US

V. Phone/Fax

Practice location:
  • Phone: 520-539-7343
  • Fax:
Mailing address:
  • Phone: 520-539-7343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number0779
License Number StateAZ

VIII. Authorized Official

Name: JESSICA BRETON
Title or Position: ACUPUNCTURIST
Credential: L.AC
Phone: 520-539-7243