Healthcare Provider Details

I. General information

NPI: 1740683127
Provider Name (Legal Business Name): SHLOMTZION MIRI SHAHAM L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2014
Last Update Date: 09/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

781 STONE LN
PALO ALTO CA
94303-4453
US

IV. Provider business mailing address

781 STONE LN
PALO ALTO CA
94303-4453
US

V. Phone/Fax

Practice location:
  • Phone: 650-830-1396
  • Fax:
Mailing address:
  • Phone: 415-535-4116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number15927
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: