Healthcare Provider Details

I. General information

NPI: 1972772127
Provider Name (Legal Business Name): AMY S BOLTON TAYLOR MITCHELL L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2008
Last Update Date: 01/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1738 SOLANO AVE
BERKELEY CA
94707-2215
US

IV. Provider business mailing address

1738 SOLANO AVE
BERKELEY CA
94707-2215
US

V. Phone/Fax

Practice location:
  • Phone: 510-558-0117
  • Fax: 510-558-8808
Mailing address:
  • Phone: 510-558-0117
  • Fax: 510-558-8808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC 10749
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: