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General NPI Number Information
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NPI Number | 1083647051
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Entity Type | Individual
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Provider Name | ANDRE MARCEL ACEBO
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Gender | Male
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Dates
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Enumeration Date | 07/10/2006
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Last Update Date | 06/18/2021
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Provider Practice Location Address
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Address Line | 325 POSADA LN SUITE A-C
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City | TEMPLETON
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State | CA
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Zip | 93465-4003
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Country | US
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Telephone | 805-542-6700
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Fax | 805-542-6791
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Provider Business Mailing Address
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Address Line | 2050 S BLOSSER RD
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City | SANTA MARIA
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State | CA
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Zip | 93458-7310
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Country | US
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Telephone | 805-361-8028
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Fax | 805-361-8097
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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 | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | DC 20074
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License Number State | CA
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