Healthcare Provider Details

I. General information

NPI: 1093886384
Provider Name (Legal Business Name): ANDREW ROBERT SEPLOW L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2320 WOOLSEY ST SUITE 100
BERKELEY CA
94705-1973
US

IV. Provider business mailing address

956 MADISON ST
ALBANY CA
94706-2025
US

V. Phone/Fax

Practice location:
  • Phone: 510-604-5518
  • Fax:
Mailing address:
  • Phone: 510-604-5518
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC 6289
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: