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General NPI Number Information
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NPI Number | 1427421148
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Entity Type | Organization
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Legal Business Name | RENEW WELLNESS ACUPUNCTURE
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Dates
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Enumeration Date | 11/03/2015
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Last Update Date | 11/03/2015
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Provider Practice Location Address
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Address Line | 5714 LONETREE BLVD
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City | ROCKLIN
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State | CA
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Zip | 95765-3734
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Country | US
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Telephone | 415-254-5267
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Fax |
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Provider Business Mailing Address
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Address Line | 2301 SUNSET BLVD 1309
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City | ROCKLIN
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State | CA
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Zip | 95765-4372
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Country | US
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Telephone | 415-254-5267
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Fax |
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Authorized Official
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Title or Position | OWNER/ ACUPUNCTURIST
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Name | KATY LING
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Credential | L.AC.
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Telephone | 415-254-5267
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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 | 11694
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License Number State | CA
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