=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598026478
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HEIDI GUILFOYLE L.AC.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/06/2012
-----------------------------------------------------
Last Update Date | 06/06/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17 AZALEA AVE
-----------------------------------------------------
City | FAIRFAX
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94930-1526
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-302-2531
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 710 C STREET SUITE 7B
-----------------------------------------------------
City | SAN RAFAEL
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94901
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-302-2531
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | AC 7625
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------