Healthcare Provider Details

I. General information

NPI: 1780962076
Provider Name (Legal Business Name): JADE DRAGON MEDICAL SPA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2011
Last Update Date: 08/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

827 BAYSIDE RD
ARCATA CA
95521-6403
US

IV. Provider business mailing address

827 BAYSIDE RD
ARCATA CA
95521-6403
US

V. Phone/Fax

Practice location:
  • Phone: 707-822-4300
  • Fax: 707-822-4330
Mailing address:
  • Phone: 707-822-4300
  • Fax: 707-822-4330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC12703
License Number StateCA

VIII. Authorized Official

Name: JESSICA BAKER
Title or Position: PRESIDENT
Credential:
Phone: 707-822-4300