Healthcare Provider Details

I. General information

NPI: 1902126576
Provider Name (Legal Business Name): AVERY ACUPUNCTURE & NATURAL MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2010
Last Update Date: 06/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

939 OAK ST
PASO ROBLES CA
93446-2580
US

IV. Provider business mailing address

939 OAK ST
PASO ROBLES CA
93446-2580
US

V. Phone/Fax

Practice location:
  • Phone: 805-400-9652
  • Fax: 805-400-9652
Mailing address:
  • Phone: 805-400-9652
  • Fax: 805-400-9652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number13614
License Number StateCA

VIII. Authorized Official

Name: VERONICA E AVERY
Title or Position: OWNER/ACUPUNCTURIST
Credential: L.AC.
Phone: 805-400-9652