Healthcare Provider Details

I. General information

NPI: 1669142659
Provider Name (Legal Business Name): NINA G BOEDDEKER L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2021
Last Update Date: 09/20/2021
Certification Date: 09/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2319 CURTIS ST
BERKELEY CA
94702-2034
US

IV. Provider business mailing address

2319 CURTIS ST
BERKELEY CA
94702-2034
US

V. Phone/Fax

Practice location:
  • Phone: 415-794-5218
  • Fax:
Mailing address:
  • Phone: 415-794-5218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number19176
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: