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General NPI Number Information
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NPI Number | 1427305754
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Entity Type | Individual
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Provider Name | ANDREA T CLOW L.AC, LMT
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Gender | Female
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Dates
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Enumeration Date | 08/06/2012
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Last Update Date | 08/06/2012
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Provider Practice Location Address
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Address Line | 14650 AVIATION BLVD SUITE 100
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City | HAWTHORNE
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State | CA
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Zip | 90250-6668
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Country | US
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Telephone | 310-725-8505
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Fax |
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Provider Business Mailing Address
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Address Line | 255 W 7TH ST APT 22
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City | SAN PEDRO
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State | CA
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Zip | 90731-0300
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Country | US
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Telephone | 704-796-5220
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Fax |
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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 | AC 14910
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License Number State | CA
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