1134899693 NPI number — LIFE RIVER ACUPUNCTURE AND INTEGRATIVE MEDICINE INC.

Table of content: DR. GERMAN GONZALEZ JR. MD (NPI 1043353691)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134899693 NPI number — LIFE RIVER ACUPUNCTURE AND INTEGRATIVE MEDICINE INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIFE RIVER ACUPUNCTURE AND INTEGRATIVE MEDICINE INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
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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:
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NPI Number Information

NPI Number:
1134899693
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/16/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9506 WINDROSE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRANITE BAY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95746-6486
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-906-0056
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9711 VILLAGE CENTER DR STE 110
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRANITE BAY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95746-6493
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-906-0056
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/16/2021

Additional Information

Authorized Official

Authorized Official Last Name:
TSENG
Authorized Official First Name:
KUOSEN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
916-906-0056

Provider Taxonomy Codes

  • Taxonomy code: 171100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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