Provider Demographics
NPI:1346420445
Name:FORATI, ANAHITA (DAOM)
Entity Type:Individual
Prefix:DR
First Name:ANAHITA
Middle Name:
Last Name:FORATI
Suffix:
Gender:F
Credentials:DAOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9022
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94709-0022
Mailing Address - Country:US
Mailing Address - Phone:510-549-3000
Mailing Address - Fax:
Practice Address - Street 1:2372 ELLSWORTH ST
Practice Address - Street 2:SUITE E
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-1580
Practice Address - Country:US
Practice Address - Phone:510-549-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-06
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00002975171100000X
CAAC12524171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA270589021OtherEMPLOYER IDENTIFICATION NUMBER