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General NPI Number Information
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NPI Number | 1235738030
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Entity Type | Individual
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Provider Name | JENNIFER VALENTINE LAC
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Gender | Female
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Dates
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Enumeration Date | 10/22/2020
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Last Update Date | 10/22/2020
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Provider Practice Location Address
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Address Line | 2911 MEDICAL ARTS ST STE 19B
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City | AUSTIN
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State | TX
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Zip | 78705-3329
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Country | US
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Telephone | 512-662-1333
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 43341
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City | AUSTIN
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State | TX
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Zip | 78704-0046
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Country | US
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Telephone | 650-815-9120
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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 | AC01985
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License Number State | TX
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