Healthcare Provider Details

I. General information

NPI: 1134550759
Provider Name (Legal Business Name): CAROL REED
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2013
Last Update Date: 12/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 HEARST AVE APT 38
BERKELEY CA
94702-1686
US

IV. Provider business mailing address

1120 HEARST AVE APT 38
BERKELEY CA
94702-1686
US

V. Phone/Fax

Practice location:
  • Phone: 208-351-0952
  • Fax:
Mailing address:
  • Phone: 208-351-0952
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number15678
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: