Healthcare Provider Details

I. General information

NPI: 1982561049
Provider Name (Legal Business Name): LARA SITA HORNBECK CMT, CST-T
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2026
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2421 4TH ST
BERKELEY CA
94710-2430
US

IV. Provider business mailing address

2421 4TH ST
BERKELEY CA
94710-2430
US

V. Phone/Fax

Practice location:
  • Phone: 510-325-2724
  • Fax:
Mailing address:
  • Phone: 510-325-2724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberCAMTC83572
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: