Healthcare Provider Details

I. General information

NPI: 1114659570
Provider Name (Legal Business Name): HANEEN SALAMEH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2022
Last Update Date: 06/25/2022
Certification Date: 06/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 ASHBY AVE
BERKELEY CA
94705-2067
US

IV. Provider business mailing address

2450 ASHBY AVE.
BERKELEY CA
94705
US

V. Phone/Fax

Practice location:
  • Phone: 510-204-6546
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-302329
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: