Healthcare Provider Details

I. General information

NPI: 1437808466
Provider Name (Legal Business Name): AKASIA SOLEIL BAMIDELE L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2022
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 SUNNYSIDE AVE STE B
MILL VALLEY CA
94941-1928
US

IV. Provider business mailing address

6701 SHELLMOUND ST APT 508
EMERYVILLE CA
94608-2455
US

V. Phone/Fax

Practice location:
  • Phone: 415-445-9388
  • Fax:
Mailing address:
  • Phone: 707-326-8963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number19886
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: