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General NPI Number Information
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NPI Number | 1720430747
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Entity Type | Organization
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Legal Business Name | TIA'S MEDICAL CENTER. INC
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Dates
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Enumeration Date | 07/02/2016
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Last Update Date | 07/02/2016
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Provider Practice Location Address
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Address Line | 9260 ALCOSTA BLVD BUILDING C SUITE 20A
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City | SAN RAMON
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State | CA
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Zip | 94583-4134
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Country | US
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Telephone | 925-913-0888
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Fax |
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Provider Business Mailing Address
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Address Line | 9260 ALCOSTA BLVD BUILDING C SUITE 20A
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City | SAN RAMON
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State | CA
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Zip | 94583-4134
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Country | US
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Telephone | 415-812-6527
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TING TING WU
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Credential |
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Telephone | 925-913-0888
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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 | AC17041
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License Number State | CA
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