Healthcare Provider Details

I. General information

NPI: 1285704346
Provider Name (Legal Business Name): ACUPUNCTURE & HERB CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

970 CAMERADO DR STE 202
CAMERON PARK CA
95682-7636
US

IV. Provider business mailing address

970 CAMERADO DR STE 202
CAMERON PARK CA
95682-7636
US

V. Phone/Fax

Practice location:
  • Phone: 530-677-0404
  • Fax: 530-677-2504
Mailing address:
  • Phone: 530-677-0404
  • Fax: 530-677-2504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC 7212
License Number StateCA

VIII. Authorized Official

Name: DAN ORTEGO
Title or Position: CFO
Credential:
Phone: 530-677-0404