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General NPI Number Information
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NPI Number | 1922548031
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Entity Type | Organization
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Legal Business Name | JENNIFER RANDOLPH ACUPUNCTURE
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Dates
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Enumeration Date | 03/08/2017
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Last Update Date | 03/08/2017
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Provider Practice Location Address
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Address Line | 302 W 5TH ST SUITE 101
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City | SAN PEDRO
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State | CA
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Zip | 90731-2738
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Country | US
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Telephone | 310-832-5818
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Fax | 310-832-7236
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Provider Business Mailing Address
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Address Line | 302 W 5TH ST SUITE 101
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City | SAN PEDRO
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State | CA
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Zip | 90731-2738
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Country | US
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Telephone | 310-832-5818
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Fax | 310-832-7236
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Authorized Official
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Title or Position | LICENSED ACUPUNCTURIST
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Name | JENNIFER LYNN RANDOLPH
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Credential | L.AC.
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Telephone | 310-832-5818
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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 | 17194
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 16368
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License Number State | CA
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