Healthcare Provider Details

I. General information

NPI: 1164578811
Provider Name (Legal Business Name): BENJAMIN EDWARD DIERAUF L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 02/18/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2920 CAMINO DIABLO STE 210C
WALNUT CREEK CA
94597-3958
US

IV. Provider business mailing address

6966 SHEPHERD CANYON RD
OAKLAND CA
94611-1539
US

V. Phone/Fax

Practice location:
  • Phone: 925-297-4785
  • Fax: 925-403-1001
Mailing address:
  • Phone: 925-297-4785
  • Fax: 925-403-1001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC 4256
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: