Healthcare Provider Details

I. General information

NPI: 1407637168
Provider Name (Legal Business Name): URSULA ANDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2023
Last Update Date: 10/09/2023
Certification Date: 10/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2576 SHATTUCK AVE
BERKELEY CA
94704-2724
US

IV. Provider business mailing address

2576 SHATTUCK AVE
BERKELEY CA
94704-2724
US

V. Phone/Fax

Practice location:
  • Phone: 831-915-1305
  • Fax:
Mailing address:
  • Phone: 831-915-1305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number66146
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: