Healthcare Provider Details

I. General information

NPI: 1528498946
Provider Name (Legal Business Name): NICO BISHOP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2013
Last Update Date: 11/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1511 TREAT BLVD #100
WALNUT CREEK CA
94598-1094
US

IV. Provider business mailing address

15550 ROCKFIELD BLVD SUITE B220
IRVINE CA
92618-2720
US

V. Phone/Fax

Practice location:
  • Phone: 925-949-8911
  • Fax: 925-949-8322
Mailing address:
  • Phone: 949-598-9999
  • Fax: 949-598-9990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC15205
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: