Healthcare Provider Details

I. General information

NPI: 1639485170
Provider Name (Legal Business Name): MARNY LYNN CULPEPPER L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2010
Last Update Date: 10/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2818 SAN PABLO AVE
BERKELEY CA
94710-2702
US

IV. Provider business mailing address

3044 1/2 TELEGRAPH AVE
BERKELEY CA
94705-2037
US

V. Phone/Fax

Practice location:
  • Phone: 415-730-6750
  • Fax: 415-952-9455
Mailing address:
  • Phone: 415-730-6750
  • Fax: 415-952-9455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC 13620
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: