Healthcare Provider Details

I. General information

NPI: 1952693962
Provider Name (Legal Business Name): GREGORY ALLEN ROSEBROOK L,AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2011
Last Update Date: 05/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1265 EL CAMINO REAL SUITE 100
SANTA CLARA CA
95050-4257
US

IV. Provider business mailing address

1265 EL CAMINO REAL SUITE 100
SANTA CLARA CA
95050-4257
US

V. Phone/Fax

Practice location:
  • Phone: 408-241-8326
  • Fax:
Mailing address:
  • Phone: 408-241-8326
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number14341
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: