Healthcare Provider Details

I. General information

NPI: 1992536635
Provider Name (Legal Business Name): STONE BRIDGE WELLNESS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2024
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36719 PORT TIDEWOOD ST
NEWARK CA
94560-3245
US

IV. Provider business mailing address

36719 PORT TIDEWOOD ST
NEWARK CA
94560-3245
US

V. Phone/Fax

Practice location:
  • Phone: 650-289-8378
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: SHI QIAO
Title or Position: OWNER
Credential:
Phone: 650-289-8378