Healthcare Provider Details

I. General information

NPI: 1851570576
Provider Name (Legal Business Name): CHRISTOPHER GENTRY L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2007
Last Update Date: 10/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 SHATTUCK AVE
BERKELEY CA
94704-2724
US

IV. Provider business mailing address

1718 LINCOLN AVE #A
ALAMEDA CA
94501-2554
US

V. Phone/Fax

Practice location:
  • Phone: 510-666-8234
  • Fax:
Mailing address:
  • Phone: 510-908-1991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC 10515
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: