Healthcare Provider Details

I. General information

NPI: 1386788933
Provider Name (Legal Business Name): MARY JANE MEES L.AC. DAOM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 11/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6639A BAY LAUREL PL
AVILA BEACH CA
93424-3504
US

IV. Provider business mailing address

PO BOX 757
AVILA BEACH CA
93424-0757
US

V. Phone/Fax

Practice location:
  • Phone: 805-705-1792
  • Fax:
Mailing address:
  • Phone: 805-705-1792
  • Fax: 805-456-0456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC8417
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: