Provider Demographics
NPI:1477015550
Name:RUMFELLO, KELSEY M (LAC)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:M
Last Name:RUMFELLO
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 1:1402 BERKELEY WAY
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94702-1520
Mailing Address - Country:US
Mailing Address - Phone:225-405-8497
Mailing Address - Fax:
Practice Address - Street 1:2818 SAN PABLO AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94702-2204
Practice Address - Country:US
Practice Address - Phone:510-214-6355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-05
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18471171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist