Healthcare Provider Details

I. General information

NPI: 1205067626
Provider Name (Legal Business Name): GOLDEN LEAF ACUPUNCTURE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2009
Last Update Date: 09/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2372 ELLSWORTH ST, STE E
BERKELEY CA
94704
US

IV. Provider business mailing address

2372 ELLSWORTH ST, STE E
BERKELEY CA
94704
US

V. Phone/Fax

Practice location:
  • Phone: 510-549-3000
  • Fax: 510-900-6577
Mailing address:
  • Phone: 510-549-3000
  • Fax: 510-900-6577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC10969
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: DR. ANAHITA FORATI
Title or Position: CEO
Credential: DAOM, LAC
Phone: 510-610-9316