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General NPI Number Information
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NPI Number | 1396955241
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Entity Type | Individual
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Provider Name | ROYA NEMATOLLAHI LAC
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Gender | Female
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 04/29/2025
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Provider Practice Location Address
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Address Line | 1012 12TH AVE S
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City | NAMPA
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State | ID
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Zip | 83651-4661
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Country | US
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Telephone | 208-999-0793
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Fax | 208-475-3091
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Provider Business Mailing Address
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Address Line | 17263 W LINDEN ST
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City | CALDWELL
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State | ID
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Zip | 83607-9209
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Country | US
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Telephone | 208-999-0793
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Fax | 208-475-3091
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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 | AC6100
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC-386
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License Number State | ID
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