Provider Demographics
NPI:1437483088
Name:KOBLAND, DIANA (LAC)
Entity Type:Individual
Prefix:MS
First Name:DIANA
Middle Name:
Last Name:KOBLAND
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 1:1730 MILVIA ST
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94709-2144
Mailing Address - Country:US
Mailing Address - Phone:415-990-5753
Mailing Address - Fax:
Practice Address - Street 1:743 ADDISON ST
Practice Address - Street 2:FLOOR 2
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94710-1929
Practice Address - Country:US
Practice Address - Phone:415-990-5753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-30
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13124171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist