Healthcare Provider Details

I. General information

NPI: 1679966725
Provider Name (Legal Business Name): JAMIE BENDER LAC, CMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2015
Last Update Date: 09/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4408 MARKET ST
OAKLAND CA
94608-3455
US

IV. Provider business mailing address

3247 SYLVAN AVE
OAKLAND CA
94602-3957
US

V. Phone/Fax

Practice location:
  • Phone: 415-336-4036
  • Fax:
Mailing address:
  • Phone: 415-336-4036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number17521
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: