Healthcare Provider Details

I. General information

NPI: 1790146082
Provider Name (Legal Business Name): AMADOR VALLEY WELLNESS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2016
Last Update Date: 03/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7660 AMADOR VALLEY BLVD SUITE D-1
DUBLIN CA
94568-2314
US

IV. Provider business mailing address

7660 AMADOR VALLEY BLVD SUITE D-1
DUBLIN CA
94568-2314
US

V. Phone/Fax

Practice location:
  • Phone: 925-829-9000
  • Fax:
Mailing address:
  • Phone: 925-829-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: ANDY AHN
Title or Position: CEO
Credential:
Phone: 925-829-9000