Healthcare Provider Details

I. General information

NPI: 1306474002
Provider Name (Legal Business Name): FORESTREAM ACUPUNCTURE & HERBS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2020
Last Update Date: 03/29/2020
Certification Date: 03/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 7TH ST
SANTA ROSA CA
95404-4255
US

IV. Provider business mailing address

901 7TH ST
SANTA ROSA CA
95404-4255
US

V. Phone/Fax

Practice location:
  • Phone: 707-815-7033
  • Fax:
Mailing address:
  • Phone: 707-815-7033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: XIAO MEI DENG
Title or Position: ACUPUNCTURIST
Credential:
Phone: 707-815-7033