Healthcare Provider Details

I. General information

NPI: 1255880902
Provider Name (Legal Business Name): OPTIMA WELLNESS ACUPUNCTURE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2016
Last Update Date: 02/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 N WIGET LN SUITE 130
WALNUT CREEK CA
94598-2435
US

IV. Provider business mailing address

1250 NEWELL AVE STE I #154
WALNUT CREEK CA
94596-5373
US

V. Phone/Fax

Practice location:
  • Phone: 925-289-8431
  • Fax:
Mailing address:
  • Phone: 925-289-8431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC 17010
License Number StateCA

VIII. Authorized Official

Name: MARIE M GUPTILL
Title or Position: OWNER
Credential: L.AC.
Phone: 925-289-8431