Healthcare Provider Details

I. General information

NPI: 1841557337
Provider Name (Legal Business Name): ALEXIS RICHARDSON L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2012
Last Update Date: 06/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

88 MESA RD
BOLINAS CA
94924
US

IV. Provider business mailing address

PO BOX 910
POINT REYES STATION CA
94956-0910
US

V. Phone/Fax

Practice location:
  • Phone: 415-663-8666
  • Fax:
Mailing address:
  • Phone: 415-663-8781
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC13515
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: