Healthcare Provider Details

I. General information

NPI: 1780928432
Provider Name (Legal Business Name): ABIGAIL SURASKY L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2012
Last Update Date: 05/30/2025
Certification Date: 05/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1911 ADDISON ST STE 102
BERKELEY CA
94704-1267
US

IV. Provider business mailing address

2206 GRANT ST
BERKELEY CA
94703-1714
US

V. Phone/Fax

Practice location:
  • Phone: 510-845-8017
  • Fax: 844-649-0670
Mailing address:
  • Phone: 510-845-8017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC3154
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: