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General NPI Number Information
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NPI Number | 1417606849
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Entity Type | Organization
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Legal Business Name | WAY OF WELLNESS HEALTHCARE INC.
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Dates
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Enumeration Date | 03/22/2022
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Last Update Date | 03/22/2022
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Provider Practice Location Address
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Address Line | 940 SARATOGA AVE STE 104
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City | SAN JOSE
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State | CA
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Zip | 95129-3409
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Country | US
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Telephone | 408-615-1995
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Fax | 408-615-1999
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Provider Business Mailing Address
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Address Line | 4719 ATHERTON AVE APT 16
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City | SAN JOSE
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State | CA
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Zip | 95130-1002
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Country | US
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Telephone | 408-615-1995
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Fax | 408-615-1999
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Authorized Official
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Title or Position | CEO
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Name | DR. SHASTA ERICSON
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Credential | L.AC., D.A.O.M.
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Telephone | 408-615-1995
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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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