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General NPI Number Information
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NPI Number | 1043418775
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Entity Type | Individual
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Provider Name | CINDY FAE ICKE L.AC., O.M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/03/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 760 MARKET ST SUITE 759
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City | SAN FRANCISCO
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State | CA
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Zip | 94102-2401
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Country | US
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Telephone | 415-262-0083
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Fax |
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Provider Business Mailing Address
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Address Line | 3532 19TH ST
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City | SAN FRANCISCO
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State | CA
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Zip | 94110-1612
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Country | US
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Telephone | 415-565-0658
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Fax |
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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 | AC 1508
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License Number State | CA
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