Healthcare Provider Details

I. General information

NPI: 1508114935
Provider Name (Legal Business Name): ACUPUNCTURE AND HOLISTIC MEDICINE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2012
Last Update Date: 08/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1283 GILMAN ST
BERKELEY CA
94706-2351
US

IV. Provider business mailing address

829 SHATTUCK AVE
BERKELEY CA
94707-2019
US

V. Phone/Fax

Practice location:
  • Phone: 510-731-7535
  • Fax:
Mailing address:
  • Phone: 510-731-7535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC13767
License Number StateCA

VIII. Authorized Official

Name: NANCY GUILD
Title or Position: BILLING MANAGER
Credential:
Phone: 714-944-8162