Healthcare Provider Details

I. General information

NPI: 1275786881
Provider Name (Legal Business Name): ANTHONY PAPE L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2008
Last Update Date: 10/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 WEBSTER ST STE 408
OAKLAND CA
94609-3149
US

IV. Provider business mailing address

330 PARK VIEW TER APT 308
OAKLAND CA
94610-4672
US

V. Phone/Fax

Practice location:
  • Phone: 510-444-2772
  • Fax:
Mailing address:
  • Phone: 510-663-5908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number12537
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: