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General NPI Number Information
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NPI Number | 1154837557
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Entity Type | Individual
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Provider Name | MICHELLE MEDINA L.AC
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Gender | Female
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Dates
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Enumeration Date | 12/20/2017
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 729 EL CERRITO PLZ
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City | EL CERRITO
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State | CA
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Zip | 94530-4022
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Country | US
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Telephone | 510-408-6120
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Fax | 510-408-6120
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Provider Business Mailing Address
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Address Line | 337 WEBSTER ST APT 5
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City | SAN FRANCISCO
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State | CA
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Zip | 94117-3534
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Country | US
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Telephone | 415-525-2837
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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 | 16910
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License Number State | CA
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