Healthcare Provider Details

I. General information

NPI: 1326426743
Provider Name (Legal Business Name): JOSH TAVES LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2015
Last Update Date: 09/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 OAK RD STE 120
WALNUT CREEK CA
94597-2039
US

IV. Provider business mailing address

1269 LINDELL DR
WALNUT CREEK CA
94596-6040
US

V. Phone/Fax

Practice location:
  • Phone: 925-785-7364
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number16474
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: