Healthcare Provider Details

I. General information

NPI: 1861852659
Provider Name (Legal Business Name): CHANTELLE LORENZ CMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2016
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2930 MCCLURE ST #4
OAKLAND CA
94609-3556
US

IV. Provider business mailing address

630 MARIPOSA AVE #102
OAKLAND CA
94610-1364
US

V. Phone/Fax

Practice location:
  • Phone: 510-463-4330
  • Fax: 510-465-4807
Mailing address:
  • Phone: 510-463-4330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number24128
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: