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General NPI Number Information
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NPI Number | 1306429121
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Entity Type | Organization
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Legal Business Name | CANYON HEALTH CENTER
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Dates
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Enumeration Date | 04/29/2021
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Last Update Date | 04/29/2021
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Provider Practice Location Address
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Address Line | 1010 RACQUET CLUB DR STE 105
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City | AUBURN
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State | CA
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Zip | 95603-3060
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Country | US
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Telephone | 530-888-0842
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Fax | 530-745-4315
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Provider Business Mailing Address
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Address Line | 1010 RACQUET CLUB DR STE 105
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City | AUBURN
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State | CA
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Zip | 95603-3060
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Country | US
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Telephone | 530-888-0842
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Fax | 530-745-4315
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Authorized Official
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Title or Position | CEO
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Name | JENNIFER MARIE REILLY
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Credential | L.AC.
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Telephone | 530-888-0842
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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 |
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License Number State |
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