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General NPI Number Information
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NPI Number | 1659815595
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Entity Type | Organization
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Legal Business Name | SANTA CRUZ NATURAL MEDICINE
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Dates
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Enumeration Date | 12/12/2016
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Last Update Date | 12/12/2016
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Provider Practice Location Address
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Address Line | 1500 GRAHAM HILL RD SUITE A
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City | SANTA CRUZ
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State | CA
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Zip | 95060-1349
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Country | US
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Telephone | 831-515-8571
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Fax |
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Provider Business Mailing Address
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Address Line | 1500 GRAHAM HILL RD SUITE A
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City | SANTA CRUZ
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State | CA
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Zip | 95060-1349
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Country | US
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Telephone | 831-515-8571
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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 | MS. TARA ANDERSON
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Credential | L.AC.
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Telephone | 831-515-8571
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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 | AC16394
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License Number State | CA
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