Healthcare Provider Details

I. General information

NPI: 1891239984
Provider Name (Legal Business Name): LINA SLEEM-GHANNAM MSOM. L.AC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2016
Last Update Date: 02/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 YGNACIO VALLEY RD STE 100
WALNUT CREEK CA
94598-3142
US

IV. Provider business mailing address

1814 YOLANDA CIR
CLAYTON CA
94517-1060
US

V. Phone/Fax

Practice location:
  • Phone: 925-285-3781
  • Fax:
Mailing address:
  • Phone: 925-285-3781
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC16430
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: