Healthcare Provider Details

I. General information

NPI: 1295281103
Provider Name (Legal Business Name): STORMS WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2016
Last Update Date: 08/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 OAK PARK BLVD SUITE B
PLEASANT HILL CA
94523-4479
US

IV. Provider business mailing address

1800 OAK PARK BLVD SUITE B
PLEASANT HILL CA
94523-4479
US

V. Phone/Fax

Practice location:
  • Phone: 925-945-7890
  • Fax: 925-945-8691
Mailing address:
  • Phone: 925-945-7890
  • Fax: 925-945-8691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC16493
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code174V00000X
TaxonomyClinical Ethicist
License NumberZ23453
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number58058
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number989463
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number581938
License Number StateCA

VIII. Authorized Official

Name: DR. ANDREW A STORMS
Title or Position: OWNER
Credential: D.C
Phone: 925-945-7890