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General NPI Number Information
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NPI Number | 1033549530
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Entity Type | Organization
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Legal Business Name | WELLSPRING ACUPUNCTURE
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Dates
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Enumeration Date | 11/19/2013
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Last Update Date | 11/19/2013
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Provider Practice Location Address
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Address Line | 45 CAMINO ALTO STE 204
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City | MILL VALLEY
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State | CA
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Zip | 94941-2935
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Country | US
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Telephone | 415-968-9294
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Fax |
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Provider Business Mailing Address
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Address Line | 5 WEATHERLY DR APT 209
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City | MILL VALLEY
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State | CA
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Zip | 94941-3287
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Country | US
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Telephone | 415-968-9294
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DANIEL GEREN
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Credential | L.AC.
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Telephone | 415-827-5375
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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 | AC15234
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License Number State | CA
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