Healthcare Provider Details

I. General information

NPI: 1669900908
Provider Name (Legal Business Name): ANNA GABRIELLE SEVERN L.AC., MSTCM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2017
Last Update Date: 05/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 18TH ST STE 103
SAN FRANCISCO CA
94114-2449
US

IV. Provider business mailing address

4520 CABRILLO ST
SAN FRANCISCO CA
94121-3214
US

V. Phone/Fax

Practice location:
  • Phone: 415-370-7341
  • Fax:
Mailing address:
  • Phone: 415-370-7341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number17576
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: