Healthcare Provider Details

I. General information

NPI: 1033549530
Provider Name (Legal Business Name): WELLSPRING ACUPUNCTURE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2013
Last Update Date: 11/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 CAMINO ALTO STE 204
MILL VALLEY CA
94941-2935
US

IV. Provider business mailing address

5 WEATHERLY DR APT 209
MILL VALLEY CA
94941-3287
US

V. Phone/Fax

Practice location:
  • Phone: 415-968-9294
  • Fax:
Mailing address:
  • Phone: 415-968-9294
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC15234
License Number StateCA

VIII. Authorized Official

Name: DANIEL GEREN
Title or Position: CEO
Credential: L.AC.
Phone: 415-827-5375