Healthcare Provider Details

I. General information

NPI: 1750918678
Provider Name (Legal Business Name): CONNIE MARIE CRONIN L. AC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2020
Last Update Date: 03/23/2020
Certification Date: 03/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3099 TELEGRAPH AVE
BERKELEY CA
94705-2035
US

IV. Provider business mailing address

574 FOREST ST
OAKLAND CA
94618-1219
US

V. Phone/Fax

Practice location:
  • Phone: 510-845-4442
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC3006
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: