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General NPI Number Information
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NPI Number | 1114102266
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Entity Type | Organization
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Legal Business Name | TCR ACUPUNCTURE
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Dates
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Enumeration Date | 01/08/2008
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Last Update Date | 01/08/2008
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Provider Practice Location Address
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Address Line | 2084 VENTURA BLVD
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City | CAMARILLO
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State | CA
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Zip | 93010-7931
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Country | US
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Telephone | 805-388-6101
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Fax |
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Provider Business Mailing Address
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Address Line | 2084 VENTURA BLVD
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City | CAMARILLO
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State | CA
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Zip | 93010-7931
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Country | US
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Telephone | 805-388-6101
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Fax |
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Authorized Official
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Title or Position | OWNER/ACUPUNCTURIST
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Name | MR. TIMOTHY RYAN
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Credential | LAC, QME
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Telephone | 805-388-6101
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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 | AC7965
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License Number State | CA
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