=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659927622
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ARIANNE MELISSA SALLABERRY OMD, LA.C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/14/2019
-----------------------------------------------------
Last Update Date | 08/14/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 661 SIERRA ROSE DR
-----------------------------------------------------
City | RENO
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89511-2060
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-982-8255
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15 WINTER ST
-----------------------------------------------------
City | RENO
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89503-5526
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-303-7086
-----------------------------------------------------
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 | 2018
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------