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General NPI Number Information
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NPI Number | 1760981617
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Entity Type | Organization
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Legal Business Name | EAST BAY ACUPUNCTURE
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Dates
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Enumeration Date | 02/06/2018
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Last Update Date | 02/06/2018
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Provider Practice Location Address
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Address Line | 440 GRAND AVE STE 401
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City | OAKLAND
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State | CA
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Zip | 94610-5032
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Country | US
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Telephone | 510-444-4141
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Fax |
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Provider Business Mailing Address
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Address Line | 440 GRAND AVE STE 401
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City | OAKLAND
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State | CA
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Zip | 94610-5032
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Country | US
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Telephone | 510-444-4141
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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 | AIMEE RUIZ
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Credential | L.AC.
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Telephone | 510-444-4141
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 14804
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License Number State | CA
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