Healthcare Provider Details

I. General information

NPI: 1679892152
Provider Name (Legal Business Name): CUPERTINO-CENTER ACUPUNCTURE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2010
Last Update Date: 05/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10301 S DE ANZA BLVD SUITE 5
CUPERTINO CA
95014-3027
US

IV. Provider business mailing address

3832 MOORPARK AVE APT 1
SAN JOSE CA
95117-1923
US

V. Phone/Fax

Practice location:
  • Phone: 408-482-7752
  • Fax:
Mailing address:
  • Phone: 408-482-7752
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TIMOTHY R CONLEY
Title or Position: BUSINESS MANAGER
Credential:
Phone: 408-482-7752