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General NPI Number Information
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NPI Number | 1043532237
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Entity Type | Individual
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Provider Name | ROSE K TAN LAC
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Gender | Female
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Dates
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Enumeration Date | 02/16/2010
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Last Update Date | 02/16/2010
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Provider Practice Location Address
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Address Line | 426 PAZZI RD
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City | WALNUT CREEK
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State | CA
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Zip | 94598-4018
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Country | US
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Telephone | 925-588-4666
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Fax |
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Provider Business Mailing Address
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Address Line | 2910 CAMINO DIABLO SUITE 210
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City | WALNUT CREEK
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State | CA
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Zip | 94597-3997
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Country | US
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Telephone | 925-588-4666
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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 | 12180
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License Number State | CA
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