Healthcare Provider Details

I. General information

NPI: 1821217878
Provider Name (Legal Business Name): MAUREEN HOVERSEN L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 CEDAR ST SUITE B
SANTA CRUZ CA
95060-4358
US

IV. Provider business mailing address

501 CEDAR ST SUITE B
SANTA CRUZ CA
95060-4358
US

V. Phone/Fax

Practice location:
  • Phone: 831-426-1093
  • Fax:
Mailing address:
  • Phone: 831-426-1093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number7929
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: