Healthcare Provider Details

I. General information

NPI: 1255660965
Provider Name (Legal Business Name): NADIA LUZ MOREDO L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NADIA LUZ OLMEDO L.AC.

II. Dates (important events)

Enumeration Date: 12/09/2009
Last Update Date: 12/09/2009
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: 510-681-8639
  • Fax:
Mailing address:
  • Phone: 510-681-8639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number11558
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: