Healthcare Provider Details

I. General information

NPI: 1477015550
Provider Name (Legal Business Name): KELSEY M RUMFELLO LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2019
Last Update Date: 04/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2818 SAN PABLO AVE
BERKELEY CA
94702-2204
US

IV. Provider business mailing address

1402 BERKELEY WAY
BERKELEY CA
94702-1520
US

V. Phone/Fax

Practice location:
  • Phone: 510-214-6355
  • Fax:
Mailing address:
  • Phone: 225-405-8497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number18471
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: