Healthcare Provider Details

I. General information

NPI: 1912670993
Provider Name (Legal Business Name): NICOLE HAN CIRELLI L.AC, DACM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2021
Last Update Date: 07/27/2021
Certification Date: 07/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 VALENCIA ST
SAN FRANCISCO CA
94103-2318
US

IV. Provider business mailing address

630 OLMSTEAD ST
SAN FRANCISCO CA
94134-1835
US

V. Phone/Fax

Practice location:
  • Phone: 415-675-8973
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number18531
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: