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General NPI Number Information
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NPI Number | 1205333903
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Entity Type | Organization
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Legal Business Name | FLOURISH INTEGRATIVE HEALTH AND ACUPUNCTURE INC.
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Dates
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Enumeration Date | 04/09/2018
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Last Update Date | 04/09/2018
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Provider Practice Location Address
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Address Line | 431 HUMBOLDT ST STE A
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City | SANTA ROSA
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State | CA
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Zip | 95404-4288
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Country | US
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Telephone | 707-205-1224
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4173
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City | SANTA ROSA
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State | CA
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Zip | 95402-4173
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Country | US
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Telephone | 707-205-1224
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | VLADISLAVA STARKOV
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Credential | LAC
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Telephone | 707-205-1224
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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 | 13901
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License Number State | CA
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