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General NPI Number Information
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NPI Number | 1205306685
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Entity Type | Organization
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Legal Business Name | CULTIVATED HEALTH ACUPUNCTURE INC.
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Dates
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Enumeration Date | 11/28/2018
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Last Update Date | 11/28/2018
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Provider Practice Location Address
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Address Line | 400 CARLTON AVE STE 7
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City | LOS GATOS
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State | CA
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Zip | 95032-2629
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Country | US
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Telephone | 408-490-0308
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 6568
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City | SAN JOSE
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State | CA
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Zip | 95150-6568
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Country | US
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Telephone | 408-049-0030
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ANDREA RUTH VANCE
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Credential | L.AC.
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Telephone | 408-490-0308
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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 |
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License Number State |
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