Healthcare Provider Details

I. General information

NPI: 1437483088
Provider Name (Legal Business Name): DIANA KOBLAND L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2009
Last Update Date: 02/11/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

743 ADDISON ST FLOOR 2
BERKELEY CA
94710-1929
US

IV. Provider business mailing address

1730 MILVIA ST
BERKELEY CA
94709-2144
US

V. Phone/Fax

Practice location:
  • Phone: 415-990-5753
  • Fax:
Mailing address:
  • Phone: 415-990-5753
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number13124
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: