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General NPI Number Information
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NPI Number | 1255667309
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Entity Type | Individual
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Provider Name | MARCIA DIANNE CONNELLY L.A.C. DTCM, DIPL.OM
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Gender | Female
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Dates
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Enumeration Date | 10/26/2009
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Last Update Date | 02/09/2026
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Provider Practice Location Address
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Address Line | 245 SEA RIDGE RD
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City | APTOS
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State | CA
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Zip | 95003-4364
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Country | US
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Telephone | 831-818-7051
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 689
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City | FREEDOM
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State | CA
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Zip | 95019-0689
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Country | US
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Telephone | 831-818-7051
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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 | 13176
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License Number State | CA
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