Healthcare Provider Details

I. General information

NPI: 1932639549
Provider Name (Legal Business Name): XIAOYAN ZHOU-MEDAGLI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3164 PUTNAM BLVD
WALNUT CREEK CA
94597
US

IV. Provider business mailing address

3164 PUTNAM BLVD
WALNUT CREEK CA
94597-1868
US

V. Phone/Fax

Practice location:
  • Phone: 925-219-5379
  • Fax: 925-930-9782
Mailing address:
  • Phone: 925-219-5379
  • Fax: 925-930-9782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC17625
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: