Healthcare Provider Details

I. General information

NPI: 1821346347
Provider Name (Legal Business Name): KATIE MCELYEA MINK LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2012
Last Update Date: 08/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 BANCROFT WAY
BERKELEY CA
94703-1710
US

IV. Provider business mailing address

1720 BANCROFT WAY
BERKELEY CA
94703-1710
US

V. Phone/Fax

Practice location:
  • Phone: 510-849-8849
  • Fax: 510-883-1438
Mailing address:
  • Phone: 510-849-8849
  • Fax: 510-883-1438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: