Healthcare Provider Details

I. General information

NPI: 1003133794
Provider Name (Legal Business Name): LAURA METZDORFF L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2010
Last Update Date: 04/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1372 N MAIN ST STE 204
WALNUT CREEK CA
94596-4692
US

IV. Provider business mailing address

1372 N MAIN ST STE 204
WALNUT CREEK CA
94596-4692
US

V. Phone/Fax

Practice location:
  • Phone: 925-280-6026
  • Fax:
Mailing address:
  • Phone: 925-280-6026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number13262
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: