1972052140 NPI number — MALAYA ACUPUNCTURE AND WELLNESS CENTER

Table of content: JANELLE VINCENT O'BOYLE ED.D., LPC (NPI 1639343213)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972052140 NPI number — MALAYA ACUPUNCTURE AND WELLNESS CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MALAYA ACUPUNCTURE AND WELLNESS CENTER
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:
1972052140
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/28/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2418 PARK BLVD APT 3
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OAKLAND
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94606-1545
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
707-407-5829
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3022 INTERNATIONAL BLVD STE 304
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OAKLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94601-2226
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-407-5829
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/28/2016

Additional Information

Authorized Official

Authorized Official Last Name:
VELASQUEZ
Authorized Official First Name:
EMIL
Authorized Official Middle Name:
M
Authorized Official Title or Position:
ACUPUNCTURIST
Authorized Official Telephone Number:
707-407-5829

Provider Taxonomy Codes

  • Taxonomy code: 302F00000X , with the licence number:  16995 , 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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