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General NPI Number Information
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NPI Number | 1063081073
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Entity Type | Individual
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Provider Name | OMAR Y CHAUDHRY L.AC
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Gender | Male
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Dates
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Enumeration Date | 06/23/2021
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Last Update Date | 06/23/2021
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Provider Practice Location Address
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Address Line | 11 ALEXANDER ST STE D
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City | WATSONVILLE
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State | CA
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Zip | 95076-4626
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Country | US
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Telephone | 831-471-7814
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Fax | 831-708-0147
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Provider Business Mailing Address
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Address Line | 151 STEPHEN RD APT A
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City | APTOS
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State | CA
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Zip | 95003-4667
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Country | US
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Telephone | 831-454-6569
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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 | 19158
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License Number State | CA
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