Healthcare Provider Details

I. General information

NPI: 1972864668
Provider Name (Legal Business Name): KAREN FISHER L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2012
Last Update Date: 05/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2522 ALPINE BLVD
ALPINE CA
91901-2208
US

IV. Provider business mailing address

850 S GRADE RD
ALPINE CA
91901-2914
US

V. Phone/Fax

Practice location:
  • Phone: 619-402-8428
  • Fax:
Mailing address:
  • Phone: 619-402-8428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC9589
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: