Healthcare Provider Details

I. General information

NPI: 1952520850
Provider Name (Legal Business Name): JOHN V MAYNES L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2320 PRINCE ST SUITE 100
BERKELEY CA
94705-1916
US

IV. Provider business mailing address

2320 PRINCE ST
BERKELEY CA
94705-1916
US

V. Phone/Fax

Practice location:
  • Phone: 510-843-7370
  • Fax: 510-843-7379
Mailing address:
  • Phone: 510-843-7370
  • Fax: 510-843-7379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number6843
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: