Healthcare Provider Details

I. General information

NPI: 1871070698
Provider Name (Legal Business Name): SARA LYNN MIZNER L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2018
Last Update Date: 07/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 SHATTUCK AVE
BERKELEY CA
94709-3402
US

IV. Provider business mailing address

1700 SHATTUCK AVE
BERKELEY CA
94709-3402
US

V. Phone/Fax

Practice location:
  • Phone: 501-470-1118
  • Fax:
Mailing address:
  • Phone: 510-470-1118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number17917
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: