Healthcare Provider Details

I. General information

NPI: 1962831925
Provider Name (Legal Business Name): MONICA BOWDITCH L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2013
Last Update Date: 11/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

999 MENLO OAKS DR
MENLO PARK CA
94025-2355
US

IV. Provider business mailing address

999 MENLO OAKS DR
MENLO PARK CA
94025-2355
US

V. Phone/Fax

Practice location:
  • Phone: 650-380-3265
  • Fax:
Mailing address:
  • Phone: 650-380-3265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number15657
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: