Healthcare Provider Details

I. General information

NPI: 1508997065
Provider Name (Legal Business Name): CARLA DALTON L. AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 BUENA AVE BERKELEY
BERKELEY CA
94703-1019
US

IV. Provider business mailing address

1720 BUENA AVE BERKELEY
BERKELEY CA
94703-1019
US

V. Phone/Fax

Practice location:
  • Phone: 510-524-4812
  • Fax: 510-524-4812
Mailing address:
  • Phone: 510-524-4812
  • Fax: 510-524-4812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC 4428
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: