Healthcare Provider Details

I. General information

NPI: 1093879033
Provider Name (Legal Business Name): THALIA LIRAIN-HAFT L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2006 DWIGHT WAY STE 204
BERKELEY CA
94704-2633
US

IV. Provider business mailing address

4222 TERRACE ST
OAKLAND CA
94611-5128
US

V. Phone/Fax

Practice location:
  • Phone: 510-547-3560
  • Fax: 510-547-1805
Mailing address:
  • Phone: 510-547-3560
  • Fax: 510-547-1805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number4582
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: