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General NPI Number Information
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NPI Number | 1538865233
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Entity Type | Organization
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Legal Business Name | THE BAMBOO CLINIC
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Dates
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Enumeration Date | 02/03/2023
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Last Update Date | 02/03/2023
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Provider Practice Location Address
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Address Line | 1110 ROSE HILL DR
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22903-5159
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Country | US
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Telephone | 415-425-8509
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2745
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22902-2745
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Country | US
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Telephone | 415-425-8509
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TAMARA BROWN
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Credential | DACM
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Telephone | 415-425-8509
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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