Healthcare Provider Details

I. General information

NPI: 1942772090
Provider Name (Legal Business Name): WHITNEY JACQUELINE BIRD L.AC, DACM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2018
Last Update Date: 04/10/2023
Certification Date: 04/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

147 LOMITA DR STE C
MILL VALLEY CA
94941-1462
US

IV. Provider business mailing address

4444 REDWOOD RD
NAPA CA
94558-9709
US

V. Phone/Fax

Practice location:
  • Phone: 415-450-5182
  • Fax:
Mailing address:
  • Phone: 415-450-5182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number18305
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: