Provider Demographics
NPI:1255660965
Name:MOREDO, NADIA LUZ (LAC)
Entity Type:Individual
Prefix:
First Name:NADIA
Middle Name:LUZ
Last Name:MOREDO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:NADIA
Other - Middle Name:LUZ
Other - Last Name:OLMEDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:2346 STUART ST
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-1109
Mailing Address - Country:US
Mailing Address - Phone:510-681-8639
Mailing Address - Fax:
Practice Address - Street 1:2346 STUART ST
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-1109
Practice Address - Country:US
Practice Address - Phone:510-681-8639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-09
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11558171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist