Healthcare Provider Details

I. General information

NPI: 1821778580
Provider Name (Legal Business Name): MR. STEVEN NICHOLAS HAIGHT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2023
Last Update Date: 07/18/2023
Certification Date: 07/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

168 SOUTHAMPTON AVE
BERKELEY CA
94707-2037
US

IV. Provider business mailing address

168 SOUTHAMPTON AVE
BERKELEY CA
94707-2037
US

V. Phone/Fax

Practice location:
  • Phone: 415-317-7591
  • Fax:
Mailing address:
  • Phone: 415-317-7591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number80300
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: