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General NPI Number Information
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NPI Number | 1306589056
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Entity Type | Individual
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Provider Name | NICOLE M ORTON LAC
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Gender | Female
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Dates
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Enumeration Date | 04/19/2022
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Last Update Date | 04/19/2022
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Provider Practice Location Address
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Address Line | 440 GRAND AVE STE 401
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City | OAKLAND
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State | CA
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Zip | 94610-5032
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Country | US
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Telephone | 510-990-1239
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Fax |
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Provider Business Mailing Address
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Address Line | 585 9TH ST UNIT 358
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City | OAKLAND
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State | CA
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Zip | 94607-3827
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Country | US
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Telephone | 510-990-1239
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 19276
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License Number State | CA
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