Healthcare Provider Details

I. General information

NPI: 1881149763
Provider Name (Legal Business Name): WEST BERKELEY WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2016
Last Update Date: 08/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2831 7TH ST
BERKELEY CA
94710-2702
US

IV. Provider business mailing address

2831 7TH ST
BERKELEY CA
94710-2702
US

V. Phone/Fax

Practice location:
  • Phone: 510-863-0333
  • Fax: 510-898-1279
Mailing address:
  • Phone: 510-863-0333
  • Fax: 510-898-1279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberA12559
License Number StateCA

VIII. Authorized Official

Name: MRS. AIMEE WELLS QUIN
Title or Position: OWNER, ACUPUNCTURIST, HERBALIST
Credential: L.AC.
Phone: 510-863-0333