Healthcare Provider Details

I. General information

NPI: 1245529080
Provider Name (Legal Business Name): JOSEPH LOUIS MACCHIAVELLI L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2011
Last Update Date: 01/12/2022
Certification Date: 01/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226 MILL ST
GRASS VALLEY CA
95945-6712
US

IV. Provider business mailing address

11500 GOLD TUNNEL CT
GOLD RIVER CA
95670-7700
US

V. Phone/Fax

Practice location:
  • Phone: 916-335-8990
  • Fax:
Mailing address:
  • Phone: 916-335-8990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC12530
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: