Healthcare Provider Details

I. General information

NPI: 1962544593
Provider Name (Legal Business Name): THE REDWOOD CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3021 TELEGRAPH AVE STE C
BERKELEY CA
94705
US

IV. Provider business mailing address

3021 TELEGRAPH AVE STE C
BERKELEY CA
94705
US

V. Phone/Fax

Practice location:
  • Phone: 510-849-1176
  • Fax: 510-849-1230
Mailing address:
  • Phone: 510-849-1176
  • Fax: 510-849-1230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: JOHN R SORDEAN
Title or Position: GENERAL MANAGER
Credential: OMD LAC
Phone: 510-849-1176