=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770165011
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MOONSHADOW ACUPUNCTURE A PROFESSIONAL CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/26/2021
-----------------------------------------------------
Last Update Date | 11/26/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3900 IRVING ST
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94122-1217
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-429-1567
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3900 IRVING ST
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94122-1217
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-429-1567
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | RAYNA LEONORA SAVROSA
-----------------------------------------------------
Credential | L.AC., DACM
-----------------------------------------------------
Telephone | 415-429-1567
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------