Healthcare Provider Details

I. General information

NPI: 1922352095
Provider Name (Legal Business Name): FIVE BRANCHES UNIVERSITY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2012
Last Update Date: 10/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 7TH AVE
SANTA CRUZ CA
95062-4669
US

IV. Provider business mailing address

200 7TH AVE
SANTA CRUZ CA
95062-4669
US

V. Phone/Fax

Practice location:
  • Phone: 831-476-8211
  • Fax: 831-476-8088
Mailing address:
  • Phone: 831-476-8211
  • Fax: 831-476-8088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: JOANNA ZHAO
Title or Position: CLINIC DIRECTOR & ACADEMIC DEAN
Credential: L.AC.
Phone: 831-476-9424