1366975609 NPI number — REDWOOD COAST ACUPUNCTURE CENTER 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 1366975609 NPI number — REDWOOD COAST ACUPUNCTURE CENTER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REDWOOD COAST ACUPUNCTURE CENTER 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:
1366975609
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/04/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2107 HARRISON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EUREKA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95501-3213
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
707-444-9446
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2107 HARRISON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EUREKA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95501-3213
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-444-9446
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/04/2017

Additional Information

Authorized Official

Authorized Official Last Name:
VODDEN
Authorized Official First Name:
RYAN
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
ACUPUNCTURIST
Authorized Official Telephone Number:
707-444-9446

Provider Taxonomy Codes

  • Taxonomy code: 171100000X , with the licence number:  5460 , 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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