=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528498946
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NICO BISHOP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/21/2013
-----------------------------------------------------
Last Update Date | 11/21/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1511 TREAT BLVD #100
-----------------------------------------------------
City | WALNUT CREEK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94598-1094
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-949-8911
-----------------------------------------------------
Fax | 925-949-8322
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15550 ROCKFIELD BLVD SUITE B220
-----------------------------------------------------
City | IRVINE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92618-2720
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-598-9999
-----------------------------------------------------
Fax | 949-598-9990
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | AC15205
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------