Healthcare Provider Details

I. General information

NPI: 1245633346
Provider Name (Legal Business Name): ASCEND ACUPUNCTURE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2014
Last Update Date: 10/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

243 GLENNORA WAY
BUELLTON CA
93427
US

IV. Provider business mailing address

270 E HIGHWAY 246 STE 222
BUELLTON CA
93427-9677
US

V. Phone/Fax

Practice location:
  • Phone: 805-895-1164
  • Fax:
Mailing address:
  • Phone: 805-895-1164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC 11733
License Number StateCA

VIII. Authorized Official

Name: DAWN WAFER
Title or Position: OWNER
Credential:
Phone: 805-895-1164