Healthcare Provider Details

I. General information

NPI: 1134452816
Provider Name (Legal Business Name): BIANCA MICHELLE MUNSON L.AC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2009
Last Update Date: 10/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2615 ASHBY AVE
BERKELEY CA
94705-2200
US

IV. Provider business mailing address

3173 RITA CT
NAPA CA
94558-3317
US

V. Phone/Fax

Practice location:
  • Phone: 707-418-0010
  • Fax:
Mailing address:
  • Phone: 707-227-7543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number13123
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: