Provider Demographics
NPI:1144875865
Name:FULL MOON ACUPUNCTURE
Entity type:Organization
Organization Name:FULL MOON ACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRACI
Authorized Official - Middle Name:VOGEL
Authorized Official - Last Name:MOREN
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:415-235-5092
Mailing Address - Street 1:2300 SPAULDING AVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94703-1628
Mailing Address - Country:US
Mailing Address - Phone:415-235-5092
Mailing Address - Fax:
Practice Address - Street 1:440 GRAND AVE STE 401
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-5032
Practice Address - Country:US
Practice Address - Phone:415-235-5092
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-08
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center