Healthcare Provider Details

I. General information

NPI: 1093844979
Provider Name (Legal Business Name): BONNIE R DIAMOND LIC. AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LEXINGTON HEALTH COLLABORATIVE 238 BEDFORD STREET - #3
LEXINGTON MA
02420
US

IV. Provider business mailing address

119 SLADE ST
BELMONT MA
02478-2226
US

V. Phone/Fax

Practice location:
  • Phone: 781-862-0898
  • Fax:
Mailing address:
  • Phone: 781-862-0898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number698
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: