Healthcare Provider Details

I. General information

NPI: 1154656700
Provider Name (Legal Business Name): EAST BAY ACUPUNCTURE & NATURAL MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2009
Last Update Date: 10/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2346 STUART ST
BERKELEY CA
94705-1109
US

IV. Provider business mailing address

2346 STUART ST
BERKELEY CA
94705-1109
US

V. Phone/Fax

Practice location:
  • Phone: 510-457-8886
  • Fax:
Mailing address:
  • Phone: 510-457-8886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC11334
License Number StateCA

VIII. Authorized Official

Name: MR. SEAN MICHAEL HALL
Title or Position: OWNER, ACUPUNCTURIST
Credential: L.AC.
Phone: 510-457-8886