Healthcare Provider Details

I. General information

NPI: 1417501883
Provider Name (Legal Business Name): ALEXANDER ACHENZA DACM, LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2019
Last Update Date: 04/28/2023
Certification Date: 04/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

837 OLNEY SANDY SPRING RD UNIT 10
SANDY SPRING MD
20860-1065
US

IV. Provider business mailing address

14608 WOONSOCKETT DR
SILVER SPRING MD
20905-5771
US

V. Phone/Fax

Practice location:
  • Phone: 410-490-3346
  • Fax:
Mailing address:
  • Phone: 215-694-9499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberU02627
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: