Healthcare Provider Details

I. General information

NPI: 1285381160
Provider Name (Legal Business Name): MORISHIGE ACUPUNCTURE, FUNCTIONAL MEDICINE & HERBAL PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2022
Last Update Date: 03/09/2022
Certification Date: 03/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1417 SANTA CRUZ DR
SANTA FE NM
87505-3861
US

IV. Provider business mailing address

2641 HENRY AVE
PINOLE CA
94564-1358
US

V. Phone/Fax

Practice location:
  • Phone: 505-690-3777
  • Fax:
Mailing address:
  • Phone: 505-690-3777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: GINA MORISHIGE
Title or Position: FOUNDER
Credential: DOM, CFMP, RX, CPT
Phone: 505-690-3777