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General NPI Number Information
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NPI Number | 1831702117
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Entity Type | Organization
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Legal Business Name | UNIFIED FUNCTIONAL MEDICINE & ACUPUNCTURE INC.
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Dates
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Enumeration Date | 08/26/2020
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Last Update Date | 08/26/2020
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Provider Practice Location Address
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Address Line | 881 RALSTON AVE
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City | BELMONT
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State | CA
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Zip | 94002-2205
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Country | US
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Telephone | 650-453-8112
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Fax |
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Provider Business Mailing Address
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Address Line | 61 KENTON AVE
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City | SAN CARLOS
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State | CA
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Zip | 94070-1748
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Country | US
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Telephone | 650-444-8771
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JONATHAN SUAREZ
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Credential | DACM, LAC
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Telephone | 650-444-8771
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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 |
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License Number State |
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