Healthcare Provider Details

I. General information

NPI: 1144257809
Provider Name (Legal Business Name): JOANNE FANUCCHI L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 CLAYTON RD SUITE D
CONCORD CA
94521-2582
US

IV. Provider business mailing address

3600 CLAYTON RD SUITE D
CONCORD CA
94521-2582
US

V. Phone/Fax

Practice location:
  • Phone: 925-497-4759
  • Fax: 925-685-3049
Mailing address:
  • Phone: 925-497-4759
  • Fax: 925-685-3049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC8892
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: