Healthcare Provider Details

I. General information

NPI: 1154624237
Provider Name (Legal Business Name): SANDRA LUDLOW L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2010
Last Update Date: 12/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2840 COLLEGE AVE
BERKELEY CA
94705-2148
US

IV. Provider business mailing address

829 SHATTUCK AVE
BERKELEY CA
94707-2019
US

V. Phone/Fax

Practice location:
  • Phone: 510-731-7535
  • Fax:
Mailing address:
  • Phone: 510-731-7535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC 13767
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: