Healthcare Provider Details

I. General information

NPI: 1508364621
Provider Name (Legal Business Name): EDITH NUNEZ ACUPUNCTURE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2018
Last Update Date: 01/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

638 STANYAN ST
SAN FRANCISCO CA
94117-1807
US

IV. Provider business mailing address

460 MARIETTA DR
SAN FRANCISCO CA
94127-1820
US

V. Phone/Fax

Practice location:
  • Phone: 415-598-7589
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number16575
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number16575
License Number StateCA

VIII. Authorized Official

Name: EDITH NUNEZ BAZA
Title or Position: ACUPUNCTURIST
Credential: L.AC.
Phone: 415-598-7589