Provider Demographics
NPI:1437415007
Name:HATLEY, BRENDA (LAC)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:HATLEY
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 1:115 1/2 CHENERY ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94131-2708
Mailing Address - Country:US
Mailing Address - Phone:415-816-6469
Mailing Address - Fax:
Practice Address - Street 1:1000 VAN NESS AVE
Practice Address - Street 2:THIRD FLOOR
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-6971
Practice Address - Country:US
Practice Address - Phone:415-633-6774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-07
Last Update Date:2012-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14662171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist