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General NPI Number Information
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NPI Number | 1912549841
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Entity Type | Organization
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Legal Business Name | ABUNDANCE ACUPUNCTURE HEALING CLINIC
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Dates
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Enumeration Date | 10/11/2019
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Last Update Date | 10/11/2019
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Provider Practice Location Address
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Address Line | 3410 MENDOCINO AVENUE
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City | SANTA ROSA
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State | CA
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Zip | 95403
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Country | US
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Telephone | 707-528-7696
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Fax | 707-596-4941
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Provider Business Mailing Address
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Address Line | 3410 MENDOCINO AVENUE
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City | SANTA ROSA
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State | CA
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Zip | 95403
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Country | US
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Telephone | 707-528-7696
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Fax | 707-596-4941
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Authorized Official
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Title or Position | LICENSED ACUPUNCTURIST
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Name | HEATHER AUSTIN
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Credential | LAC
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Telephone | 707-528-7696
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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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