Healthcare Provider Details

I. General information

NPI: 1689123994
Provider Name (Legal Business Name): DEBORAH ROSEN KANOFSKY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2016
Last Update Date: 09/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2320 WOOLSEY ST SUITE 100
BERKELEY CA
94705-1973
US

IV. Provider business mailing address

2320 WOOLSEY ST SUITE 100
BERKELEY CA
94705-1973
US

V. Phone/Fax

Practice location:
  • Phone: 925-952-9688
  • Fax: 510-843-7379
Mailing address:
  • Phone: 925-952-9688
  • Fax: 510-843-7379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC2571
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: