Healthcare Provider Details

I. General information

NPI: 1114531837
Provider Name (Legal Business Name): RESHAM MACFARLANE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2020
Last Update Date: 08/31/2020
Certification Date: 08/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3025 DANA ST
BERKELEY CA
94705-2041
US

IV. Provider business mailing address

3025 DANA ST
BERKELEY CA
94705-2041
US

V. Phone/Fax

Practice location:
  • Phone: 408-580-7281
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number73713
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number73713
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: