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General NPI Number Information
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NPI Number | 1942330550
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Entity Type | Individual
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Provider Name | JASMINE DEBRA BERKE L.AC., D.A.O.M.
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Gender | Female
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Dates
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Enumeration Date | 03/06/2007
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Last Update Date | 03/10/2011
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Provider Practice Location Address
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Address Line | 2425 PORTER STREET
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City | SOQUEL
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State | CA
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Zip | 95073
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Country | US
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Telephone | 831-479-1036
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Fax | 831-401-2604
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Provider Business Mailing Address
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Address Line | 521 CAPITOLA AVE SUITE A
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City | CAPITOLA
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State | CA
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Zip | 95010-2759
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Country | US
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Telephone | 831-479-1036
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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 | AC 4357
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License Number State | CA
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