Healthcare Provider Details

I. General information

NPI: 1982947206
Provider Name (Legal Business Name): NANCY DEQIONG MO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2013
Last Update Date: 04/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10050 GARVEY AVE STE 103
EL MONTE CA
91733-2089
US

IV. Provider business mailing address

230 N NICHOLSON AVE APT D
MONTEREY PARK CA
91755-1835
US

V. Phone/Fax

Practice location:
  • Phone: 626-731-8806
  • Fax:
Mailing address:
  • Phone: 626-731-8806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC 7125
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: