Healthcare Provider Details

I. General information

NPI: 1972051571
Provider Name (Legal Business Name): PROTEA ACUPUNCTURE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2016
Last Update Date: 08/09/2022
Certification Date: 08/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1905 PALMETTO AVE STE D
PACIFICA CA
94044-2573
US

IV. Provider business mailing address

1905 PALMETTO AVE STE D
PACIFICA CA
94044-2573
US

V. Phone/Fax

Practice location:
  • Phone: 415-758-3444
  • Fax:
Mailing address:
  • Phone: 415-758-3444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number16062
License Number StateCA

VIII. Authorized Official

Name: HEATHER L BEDIENT
Title or Position: LICENSED ACUPUNCTURIST
Credential: L.AC
Phone: 415-758-3444