Healthcare Provider Details

I. General information

NPI: 1467061853
Provider Name (Legal Business Name): SYDNEY MALAWER LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2020
Last Update Date: 07/30/2020
Certification Date: 07/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1283 GILMAN ST
BERKELEY CA
94706-2351
US

IV. Provider business mailing address

1035 VIRGINIA ST
BERKELEY CA
94710-1852
US

V. Phone/Fax

Practice location:
  • Phone: 510-214-2980
  • Fax:
Mailing address:
  • Phone: 914-584-4239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number18835
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: