Healthcare Provider Details

I. General information

NPI: 1164020889
Provider Name (Legal Business Name): ADELIZ ARAIZA LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2020
Last Update Date: 10/14/2020
Certification Date: 10/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1351 HARRISON ST
SAN FRANCISCO CA
94103-4334
US

IV. Provider business mailing address

2957 22ND ST
SAN FRANCISCO CA
94110-3334
US

V. Phone/Fax

Practice location:
  • Phone: 415-864-1070
  • Fax:
Mailing address:
  • Phone: 415-618-9824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number18725
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: