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General NPI Number Information
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NPI Number | 1013155712
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Entity Type | Individual
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Provider Name | ERIN STEPHANIE PRUCHA M.S.O.M, L.AC.
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Gender | Female
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Dates
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Enumeration Date | 02/03/2009
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Last Update Date | 12/16/2024
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Provider Practice Location Address
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Address Line | 2460 W 3RD ST STE 240
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City | SANTA ROSA
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State | CA
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Zip | 95401-6404
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Country | US
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Telephone | 707-888-4940
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Fax | 844-598-6536
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Provider Business Mailing Address
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Address Line | 429 MALLARD DR
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City | SANTA ROSA
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State | CA
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Zip | 95401-5765
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Country | US
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Telephone | 707-888-4940
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Fax | 844-598-6536
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | CA 12220
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License Number State | CA
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