Healthcare Provider Details

I. General information

NPI: 1174681415
Provider Name (Legal Business Name): DANIEL JESSE PAIGE M.S., L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 05/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1738 SOLANO AVE
BERKELEY CA
94707-2215
US

IV. Provider business mailing address

1204 MARIN AVE
ALBANY CA
94706-2018
US

V. Phone/Fax

Practice location:
  • Phone: 510-292-8793
  • Fax:
Mailing address:
  • Phone: 510-292-8793
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC 10922
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: