Healthcare Provider Details

I. General information

NPI: 1821206038
Provider Name (Legal Business Name): DINA FIDEL L. AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2007
Last Update Date: 03/29/2022
Certification Date: 03/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3734 FARM HILL BLVD
REDWOOD CITY CA
94061-1810
US

IV. Provider business mailing address

3734 FARM HILL BLVD
REDWOOD CITY CA
94061-1810
US

V. Phone/Fax

Practice location:
  • Phone: 650-346-7027
  • Fax: 408-481-4764
Mailing address:
  • Phone: 650-346-7027
  • Fax: 408-481-4764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC7658
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: