Healthcare Provider Details

I. General information

NPI: 1710123583
Provider Name (Legal Business Name): TRACY ANN ZOLLINGER L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2008
Last Update Date: 03/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2424 BLANDING AVE SUITE 102
ALAMEDA CA
94501-1553
US

IV. Provider business mailing address

2424 BLANDING AVE SUITE 102
ALAMEDA CA
94501-1553
US

V. Phone/Fax

Practice location:
  • Phone: 510-299-0057
  • Fax:
Mailing address:
  • Phone: 510-299-0057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC12380
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: