Healthcare Provider Details

I. General information

NPI: 1689014342
Provider Name (Legal Business Name): THOMAS EDWARD AHLBORN PH.D. LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2013
Last Update Date: 06/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 CIVIC DR SUITE 111
WALNUT CREEK CA
94596-3895
US

IV. Provider business mailing address

1735 WESTWOOD DR
CONCORD CA
94521-1233
US

V. Phone/Fax

Practice location:
  • Phone: 925-977-1638
  • Fax: 925-977-1639
Mailing address:
  • Phone: 925-826-9102
  • Fax: 925-977-1639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC 15264
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: