Healthcare Provider Details

I. General information

NPI: 1124558010
Provider Name (Legal Business Name): HILARY MUSAJI LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2017
Last Update Date: 03/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 SHATTUCK AVE
BERKELEY CA
94709-3402
US

IV. Provider business mailing address

1107 EVELYN AVE
ALBANY CA
94706-2315
US

V. Phone/Fax

Practice location:
  • Phone: 510-307-6634
  • Fax: 510-295-2749
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number17661
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number17661
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: