Healthcare Provider Details

I. General information

NPI: 1346881489
Provider Name (Legal Business Name): HERBAL LANDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2019
Last Update Date: 09/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2485 AUTUMNVALE DR, STE D
SAN JOSE CA
95131
US

IV. Provider business mailing address

2485 AUTUMNVALE DR, STE D
SAN JOSE CA
95131
US

V. Phone/Fax

Practice location:
  • Phone: 408-909-0325
  • Fax:
Mailing address:
  • Phone: 408-909-0325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: KAKARLA MADHAVAN
Title or Position: MANAGER
Credential:
Phone: 408-909-0325