Healthcare Provider Details

I. General information

NPI: 1053699801
Provider Name (Legal Business Name): NIKOO ROSE SALEH KASMAI L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NIKOO KASMAI L.AC.

II. Dates (important events)

Enumeration Date: 07/28/2011
Last Update Date: 04/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 LA CASA VIA SUITE 200
WALNUT CREEK CA
94598-3088
US

IV. Provider business mailing address

110 LA CASA VIA SUITE 200
WALNUT CREEK CA
94598-3088
US

V. Phone/Fax

Practice location:
  • Phone: 925-567-3337
  • Fax:
Mailing address:
  • Phone: 925-567-3337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number14042
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: