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General NPI Number Information
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NPI Number | 1972051571
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Entity Type | Organization
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Legal Business Name | PROTEA ACUPUNCTURE
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Dates
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Enumeration Date | 09/13/2016
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Last Update Date | 08/09/2022
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Provider Practice Location Address
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Address Line | 1905 PALMETTO AVE STE D
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City | PACIFICA
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State | CA
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Zip | 94044-2573
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Country | US
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Telephone | 415-758-3444
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Fax |
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Provider Business Mailing Address
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Address Line | 1905 PALMETTO AVE STE D
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City | PACIFICA
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State | CA
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Zip | 94044-2573
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Country | US
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Telephone | 415-758-3444
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Fax |
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Authorized Official
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Title or Position | LICENSED ACUPUNCTURIST
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Name | HEATHER L BEDIENT
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Credential | L.AC
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Telephone | 415-758-3444
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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 | 16062
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License Number State | CA
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