1205273877 NPI number — JANE HEALTH AND MASSAGE CLINIC LLC

Table of content: (NPI 1205273877)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205273877 NPI number — JANE HEALTH AND MASSAGE CLINIC LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JANE HEALTH AND MASSAGE CLINIC LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ACE ACUHERB CLINIC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205273877
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/23/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12116 WILSEY WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POWAY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92064-2824
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-456-8026
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9285 DOWDY DR
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92126-6379
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-842-8817
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/23/2013

Additional Information

Authorized Official

Authorized Official Last Name:
ZHAO
Authorized Official First Name:
JIFU
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
360-456-8026

Provider Taxonomy Codes

  • Taxonomy code: 171100000X , with the licence number:  AC 11525 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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