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General NPI Number Information
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NPI Number | 1134350184
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Entity Type | Organization
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Legal Business Name | BAYTREE WELLNESS CENTER
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Dates
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Enumeration Date | 08/06/2009
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Last Update Date | 08/06/2009
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Provider Practice Location Address
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Address Line | 1650 S AMPHLETT BLVD STE 224
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City | SAN MATEO
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State | CA
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Zip | 94402-2529
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Country | US
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Telephone | 650-344-8499
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Fax | 650-344-8499
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Provider Business Mailing Address
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Address Line | 1650 S AMPHLETT BLVD STE 224
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City | SAN MATEO
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State | CA
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Zip | 94402-2529
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Country | US
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Telephone | 650-344-8499
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Fax | 650-344-8499
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Authorized Official
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Title or Position | PAARTNER
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Name | STEPHANIE LACARRUBBA
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Credential |
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Telephone | 650-344-8499
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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 | 5511
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 10779
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License Number State | CA
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