Active NPI
Jennifer Daltilio, L.AC.
- Acupuncturist
- Phoenix, AZ
National Provider Identifier
1497271191
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Acupuncturist
- License
- 1069
- Practice address
- 301 E Bethany Home Rd
Phoenix, AZ 85012-1263 - Phone
- (602) 503-8875
- NPI assigned
- Aug 15, 2017
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Acupuncturist | 171100000X | 1069 | AZ | Primary |
Addresses
Primary practice location
301 E Bethany Home Rd
Phoenix, AZ 85012-1263
Mailing address
PO Box 10252
Glendale, AZ 85318-0252
Phone (602) 503-8875
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1069 | AZ | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1502755200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1497271191",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 10252",
"city": "GLENDALE",
"state": "AZ",
"postal_code": "853180252",
"telephone_number": "602-503-8875"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "301 E BETHANY HOME RD",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850121263",
"telephone_number": "602-503-8875"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DALTILIO",
"first_name": "JENNIFER",
"credential": "L.AC.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-08-15",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "171100000X",
"taxonomy_group": "",
"desc": "Acupuncturist",
"state": "AZ",
"license": "1069",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Phoenix, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.