Healthcare Provider Details

I. General information

NPI: 1750131801
Provider Name (Legal Business Name): SHENSOMA ACUPUNCTURE, A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2024
Last Update Date: 03/22/2024
Certification Date: 03/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1832 AVONDALE AVE STE 4
SACRAMENTO CA
95825-1386
US

IV. Provider business mailing address

1832 AVONDALE AVE STE 4
SACRAMENTO CA
95825-1386
US

V. Phone/Fax

Practice location:
  • Phone: 916-222-8012
  • Fax:
Mailing address:
  • Phone: 916-222-8012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ESTELLA CERVANTEZ
Title or Position: ACUPUNCTURIST
Credential: DACM, LAC
Phone: 916-222-8012