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General NPI Number Information
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NPI Number | 1073093472
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Entity Type | Organization
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Legal Business Name | PIVOT ACUPUNCTURE & INTEGRATIVE HEALTH INC
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Dates
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Enumeration Date | 08/16/2018
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Last Update Date | 08/16/2018
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Provider Practice Location Address
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Address Line | 480 REDWOOD ST STE 14
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City | VALLEJO
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State | CA
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Zip | 94590-2958
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Country | US
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Telephone | 707-653-0495
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Fax | 707-638-0384
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Provider Business Mailing Address
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Address Line | 480 REDWOOD ST STE 14
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City | VALLEJO
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State | CA
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Zip | 94590-2958
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Country | US
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Telephone | 707-653-0495
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Fax | 707-638-0384
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Authorized Official
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Title or Position | CEO
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Name | SHAWNE J LOPES
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Credential | LAC
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Telephone | 707-653-0495
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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 | AC16814
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License Number State | CA
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