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General NPI Number Information
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NPI Number | 1376508622
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Entity Type | Individual
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Provider Name | WENDY BALLEN L. AC.
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Gender | Female
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Dates
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Enumeration Date | 04/19/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 632 FREDERICK ST
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City | SANTA CRUZ
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State | CA
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Zip | 95062-2203
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Country | US
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Telephone | 831-423-2037
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Fax | 831-423-2037
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Provider Business Mailing Address
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Address Line | 1911 COURTYARD DR
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City | CAPITOLA
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State | CA
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Zip | 95010-3563
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Country | US
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Telephone | 831-475-0166
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Fax | 831-423-2037
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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 | CA5369
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License Number State | CA
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