Healthcare Provider Details

I. General information

NPI: 1922387802
Provider Name (Legal Business Name): DENNIS WERDMULLER VON ELGG L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2011
Last Update Date: 08/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2320 WOOLSEY ST STE 100
BERKELEY CA
94705-1974
US

IV. Provider business mailing address

2320 WOOLSEY STREET, SUITE 100
BERKELEY CA
94703
US

V. Phone/Fax

Practice location:
  • Phone: 510-883-1340
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberCA7690
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: