Healthcare Provider Details

I. General information

NPI: 1770163461
Provider Name (Legal Business Name): JESSICA ANN BIEDRON L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2021
Last Update Date: 04/08/2021
Certification Date: 04/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 CHENERY ST
SAN FRANCISCO CA
94131-3095
US

IV. Provider business mailing address

2038 PARKER ST UNIT 322
BERKELEY CA
94704-3272
US

V. Phone/Fax

Practice location:
  • Phone: 415-585-1990
  • Fax:
Mailing address:
  • Phone: 415-385-6445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC14095
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: