Healthcare Provider Details

I. General information

NPI: 1811257504
Provider Name (Legal Business Name): PETER BUIS L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2012
Last Update Date: 05/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2148 MARKET ST
SAN FRANCISCO CA
94114-1319
US

IV. Provider business mailing address

2148 MARKET ST
SAN FRANCISCO CA
94114-1319
US

V. Phone/Fax

Practice location:
  • Phone: 415-690-8150
  • Fax:
Mailing address:
  • Phone: 415-690-8150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC 14636
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: