Healthcare Provider Details

I. General information

NPI: 1780742098
Provider Name (Legal Business Name): SUSAN BEDFORD L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

632 FREDERICK ST
SANTA CRUZ CA
95062-2203
US

IV. Provider business mailing address

632 FREDERICK ST
SANTA CRUZ CA
95062-2203
US

V. Phone/Fax

Practice location:
  • Phone: 831-423-4378
  • Fax:
Mailing address:
  • Phone: 831-423-4378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC1458
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: