Healthcare Provider Details

I. General information

NPI: 1922270719
Provider Name (Legal Business Name): KAREN REYNOLDS ACUPUNCTURE AND ORIENTAL MEDICINE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2008
Last Update Date: 04/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 MILLER AVE
MILL VALLEY CA
94941-2990
US

IV. Provider business mailing address

600 MILLER AVE
MILL VALLEY CA
94941-2990
US

V. Phone/Fax

Practice location:
  • Phone: 415-381-8500
  • Fax: 415-381-8558
Mailing address:
  • Phone: 415-381-8500
  • Fax: 415-381-8558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number7821
License Number StateCA

VIII. Authorized Official

Name: MS. KAREN ANN REYNOLDS
Title or Position: PRESIDENT
Credential: L.AC.
Phone: 415-381-8500