Healthcare Provider Details

I. General information

NPI: 1992942791
Provider Name (Legal Business Name): ANAHITA ACUPUNCTURE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2009
Last Update Date: 01/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1456 SAN PABLO AVE
BERKELEY CA
94702-1046
US

IV. Provider business mailing address

PO BOX 9022
BERKELEY CA
94709-0022
US

V. Phone/Fax

Practice location:
  • Phone: 510-292-1627
  • Fax: 267-480-4612
Mailing address:
  • Phone: 510-292-1627
  • Fax: 267-480-4612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC 12524
License Number StateCA

VIII. Authorized Official

Name: DR. ANAHITA FORATI
Title or Position: OWNER
Credential: DAOM, L.AC
Phone: 510-292-1627