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General NPI Number Information
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NPI Number | 1023552692
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Entity Type | Organization
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Legal Business Name | FERNANDES ACUPUNCTURE AND CHINESE HERBAL MEDICINE, INC.
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Dates
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Enumeration Date | 12/15/2016
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Last Update Date | 12/15/2016
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Provider Practice Location Address
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Address Line | 277 MAIN ST SUITE 208
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City | MARLBOROUGH
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State | MA
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Zip | 01752-5508
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Country | US
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Telephone | 978-473-9393
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Fax | 978-568-0767
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Provider Business Mailing Address
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Address Line | 277 MAIN ST SUITE 208
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City | MARLBOROUGH
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State | MA
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Zip | 01752-5508
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Country | US
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Telephone | 978-473-9393
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Fax | 978-568-0767
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Authorized Official
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Title or Position | OWNER
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Name | DIANA LISA FERNANDES
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Credential | LIC. AC., M.A.O.M.
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Telephone | 978-473-9393
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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 | 233902
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License Number State | MA
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