Healthcare Provider Details

I. General information

NPI: 1740772862
Provider Name (Legal Business Name): JIA ZHU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2018
Last Update Date: 06/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 SIERRA VISTA DR
MONTEREY CA
93940-6011
US

IV. Provider business mailing address

55 SIERRA VISTA DR
MONTEREY CA
93940-6011
US

V. Phone/Fax

Practice location:
  • Phone: 831-373-4208
  • Fax:
Mailing address:
  • Phone: 831-373-4208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number64815
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number18072
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: