Provider Demographics
NPI:1992536635
Name:STONE BRIDGE WELLNESS INC
Entity type:Organization
Organization Name:STONE BRIDGE WELLNESS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHI
Authorized Official - Middle Name:
Authorized Official - Last Name:QIAO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-289-8378
Mailing Address - Street 1:936 MOUTON CIR
Mailing Address - Street 2:
Mailing Address - City:EAST PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94303-2545
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:936 MOUTON CIR
Practice Address - Street 2:
Practice Address - City:EAST PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94303-2545
Practice Address - Country:US
Practice Address - Phone:650-289-8378
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-13
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty