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General NPI Number Information
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NPI Number | 1255880902
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Entity Type | Organization
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Legal Business Name | OPTIMA WELLNESS ACUPUNCTURE
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Dates
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Enumeration Date | 09/22/2016
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Last Update Date | 02/07/2017
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Provider Practice Location Address
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Address Line | 325 N WIGET LN SUITE 130
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City | WALNUT CREEK
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State | CA
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Zip | 94598-2435
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Country | US
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Telephone | 925-289-8431
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Fax |
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Provider Business Mailing Address
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Address Line | 1250 NEWELL AVE STE I #154
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City | WALNUT CREEK
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State | CA
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Zip | 94596-5373
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Country | US
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Telephone | 925-289-8431
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARIE M GUPTILL
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Credential | L.AC.
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Telephone | 925-289-8431
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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 17010
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License Number State | CA
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