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General NPI Number Information
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NPI Number | 1558685214
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Entity Type | Individual
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Provider Name | NICOLE FUGO ZIBELMAN LAC
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Gender | Female
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Dates
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Enumeration Date | 03/23/2010
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 616 PETALUMA BLVD N STE B
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City | PETALUMA
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State | CA
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Zip | 94952-2847
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Country | US
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Telephone | 415-295-6108
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Fax | 415-226-0170
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Provider Business Mailing Address
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Address Line | 1422 DEBRA DR
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City | PETALUMA
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State | CA
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Zip | 94954-5425
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Country | US
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Telephone | 415-295-6108
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Fax | 415-226-0170
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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 | AK000965
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC15158
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License Number State | CA
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