1659419265 NPI number — BYRD ACUPUNCTURE, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659419265 NPI number — BYRD ACUPUNCTURE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BYRD ACUPUNCTURE, INC.
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:
Provider Other Organization Name Type Code:
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:
1659419265
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1905 JOSE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANTA CRUZ
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95062-1603
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
831-479-8809
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20 S SANTA CRUZ AVE
Provider Second Line Business Practice Location Address:
SUITE 307
Provider Business Practice Location Address City Name:
LOS GATOS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95030-6830
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
408-399-6114
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/03/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BYRD
Authorized Official First Name:
DUANE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
831-295-3541

Provider Taxonomy Codes

  • Taxonomy code: 171100000X , with the licence number:  AC 11328 , 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)