=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982021234
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROBIN GREEN ACUPUNCTURE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/25/2014
-----------------------------------------------------
Last Update Date | 03/25/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15585 MONTEREY ST. STE C
-----------------------------------------------------
City | MORGAN HILL
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95037
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-776-0420
-----------------------------------------------------
Fax | 408-776-0424
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15585 MONTEREY ST. STE C
-----------------------------------------------------
City | MORGAN HILL
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95037
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-776-0420
-----------------------------------------------------
Fax | 408-776-0424
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ROBIN GREEN
-----------------------------------------------------
Credential | LAC.
-----------------------------------------------------
Telephone | 408-776-0420
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------