Healthcare Provider Details

I. General information

NPI: 1598726127
Provider Name (Legal Business Name): LINNIE ELAINE O'FLANAGAN-GORRE L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: LINNIE ELAINE O'FLANAGAN L.AC.

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 MEADOW VISTA RD
MEADOW VISTA CA
95722-9534
US

IV. Provider business mailing address

1700 MEADOW VISTA RD
MEADOW VISTA CA
95722-9534
US

V. Phone/Fax

Practice location:
  • Phone: 530-878-4828
  • Fax:
Mailing address:
  • Phone: 530-878-4828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC 7618
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: