=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306926522
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROBYN ERIKA SEIDEN L.AC.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/16/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 343 COLLEGE AVE
-----------------------------------------------------
City | SANTA ROSA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95401-5117
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-483-3421
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4332 FISTOR DR
-----------------------------------------------------
City | SANTA ROSA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95409-2617
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-537-8217
-----------------------------------------------------
Fax | 707-537-8217
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | AC9637
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------