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General NPI Number Information
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NPI Number | 1306146766
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Entity Type | Individual
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Provider Name | ANDREA FUZIMOTO L.AC.
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Gender | Female
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Dates
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Enumeration Date | 11/01/2010
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Last Update Date | 10/27/2011
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Provider Practice Location Address
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Address Line | 405 KAINS AVE
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City | ALBANY
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State | CA
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Zip | 94706-1271
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Country | US
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Telephone | 510-384-1751
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Fax |
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Provider Business Mailing Address
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Address Line | 1286 61ST ST
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City | EMERYVILLE
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State | CA
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Zip | 94608-2133
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Country | US
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Telephone | 510-384-1751
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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 | AC 13455
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License Number State | CA
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