Healthcare Provider Details

I. General information

NPI: 1871348482
Provider Name (Legal Business Name): GATHERING BLUE ACUPUNCTURE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2024
Last Update Date: 04/18/2024
Certification Date: 04/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1516 MAIN ST STE 104
RAMONA CA
92065-5242
US

IV. Provider business mailing address

1516 MAIN ST STE 104
RAMONA CA
92065-5242
US

V. Phone/Fax

Practice location:
  • Phone: 760-896-1333
  • Fax:
Mailing address:
  • Phone: 760-896-1333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DARON MATHENA
Title or Position: DOCTOR/OWNER
Credential: DACM, L.AC.
Phone: 760-896-1333