Healthcare Provider Details

I. General information

NPI: 1912246679
Provider Name (Legal Business Name): FAMILY COMMUNITY ACUPUNCTURE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2013
Last Update Date: 01/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

980 LINDA MAR BLVD
PACIFICA CA
94044-3542
US

IV. Provider business mailing address

980 LINDA MAR BLVD
PACIFICA CA
94044-3542
US

V. Phone/Fax

Practice location:
  • Phone: 650-380-6055
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC 12299
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC 12103
License Number StateCA

VIII. Authorized Official

Name: KIM REECE
Title or Position: OWNER
Credential: L.AC., CMT
Phone: 650-355-3600