Healthcare Provider Details

I. General information

NPI: 1205329430
Provider Name (Legal Business Name): STEPHANIE EDMAN L.AC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2018
Last Update Date: 11/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

276 S. MILL ST. SUITE A
TEHACHAPI CA
93561
US

IV. Provider business mailing address

7357 HILLROSE ST
TUJUNGA CA
91042
US

V. Phone/Fax

Practice location:
  • Phone: 661-282-0648
  • Fax:
Mailing address:
  • Phone: 818-279-4078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number18121
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: