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General NPI Number Information
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NPI Number | 1669542163
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Entity Type | Individual
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Provider Name | SHELLY RENE BORONDA L.AC.
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Gender | Female
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Dates
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Enumeration Date | 11/09/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 8935 MORRO RD STE 3
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City | ATASCADERO
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State | CA
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Zip | 93422-3923
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Country | US
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Telephone | 805-462-1501
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Fax | 805-434-9311
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Provider Business Mailing Address
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Address Line | 8935 MORRO RD, STE 3
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City | ATASCADERO
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State | CA
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Zip | 93422
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Country | US
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Telephone | 805-462-1501
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Fax | 805-434-9311
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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 | AC9120
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License Number State | CA
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