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General NPI Number Information
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NPI Number | 1972052140
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Entity Type | Organization
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Legal Business Name | MALAYA ACUPUNCTURE AND WELLNESS CENTER
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Dates
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Enumeration Date | 09/28/2016
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Last Update Date | 09/28/2016
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Provider Practice Location Address
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Address Line | 3022 INTERNATIONAL BLVD STE 304
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City | OAKLAND
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State | CA
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Zip | 94601-2226
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Country | US
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Telephone | 707-407-5829
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Fax |
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Provider Business Mailing Address
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Address Line | 2418 PARK BLVD APT 3
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City | OAKLAND
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State | CA
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Zip | 94606-1545
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Country | US
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Telephone | 707-407-5829
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Fax |
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Authorized Official
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Title or Position | ACUPUNCTURIST
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Name | MR. EMIL M VELASQUEZ
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Credential | L.AC
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Telephone | 707-407-5829
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | 16995
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License Number State | CA
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