Healthcare Provider Details
I. General information
NPI: 1972032589
Provider Name (Legal Business Name): BREATHE HOLISTIC HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 06/07/2017
Last Update Date: 06/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
900 N SAN ANTONIO RD
LOS ALTOS CA
94022-1373
US
IV. Provider business mailing address
1288 ALBION LN
SUNNYVALE CA
94087-3827
US
V. Phone/Fax
- Phone: 408-464-5545
- Fax:
- Phone: 408-464-5545
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 171100000X |
| Taxonomy | Acupuncturist |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 175F00000X |
| Taxonomy | Naturopath |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
LIAT
HOD
Title or Position: CEO
Credential: L.AC
Phone: 408-464-5545