Provider Demographics
NPI:1770519613
Name:RANKIN, SARA JESSICA (LAC)
Entity type:Individual
Prefix:MS
First Name:SARA
Middle Name:JESSICA
Last Name:RANKIN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3535 GRAND AVE
Mailing Address - Street 2:1
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-2011
Mailing Address - Country:US
Mailing Address - Phone:510-593-7514
Mailing Address - Fax:877-897-3875
Practice Address - Street 1:3535 GRAND AVE
Practice Address - Street 2:1
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-2011
Practice Address - Country:US
Practice Address - Phone:510-593-7514
Practice Address - Fax:877-897-3875
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC8020171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC8020OtherSTATE ACUPUNCTURE LICENSE