Healthcare Provider Details

I. General information

NPI: 1487089868
Provider Name (Legal Business Name): KATIE LEWIS L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2013
Last Update Date: 09/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2031 6TH ST
BERKELEY CA
94710-2006
US

IV. Provider business mailing address

439 36TH ST
OAKLAND CA
94609-2810
US

V. Phone/Fax

Practice location:
  • Phone: 510-981-4100
  • Fax:
Mailing address:
  • Phone: 207-294-2372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC 15240
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: