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General NPI Number Information
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NPI Number | 1205273877
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Entity Type | Organization
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Legal Business Name | JANE HEALTH AND MASSAGE CLINIC LLC
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Dates
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Enumeration Date | 05/23/2013
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Last Update Date | 05/23/2013
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Provider Practice Location Address
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Address Line | 9285 DOWDY DR SUITE 103
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City | SAN DIEGO
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State | CA
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Zip | 92126-6379
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Country | US
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Telephone | 858-842-8817
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Fax |
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Provider Business Mailing Address
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Address Line | 12116 WILSEY WAY
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City | POWAY
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State | CA
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Zip | 92064-2824
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Country | US
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Telephone | 360-456-8026
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | MR. JIFU ZHAO
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Credential | PH. D.
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Telephone | 360-456-8026
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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 | AC 11525
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License Number State | CA
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