Healthcare Provider Details

I. General information

NPI: 1538464334
Provider Name (Legal Business Name): MARJORIE T. MAGGENTI L.AC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2011
Last Update Date: 02/11/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2006 DWIGHT WAY STE 208
BERKELEY CA
94704-2633
US

IV. Provider business mailing address

PO BOX 9427
BERKELEY CA
94709-0427
US

V. Phone/Fax

Practice location:
  • Phone: 510-684-1853
  • Fax:
Mailing address:
  • Phone: 510-684-1853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number11620
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: