Provider Demographics
NPI:1699029835
Name:LONG, JAMIE ELIZABETH (LAC)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:ELIZABETH
Last Name:LONG
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 1:5661 KEITH AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94618-1542
Mailing Address - Country:US
Mailing Address - Phone:510-287-5732
Mailing Address - Fax:
Practice Address - Street 1:5661 KEITH AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94618-1542
Practice Address - Country:US
Practice Address - Phone:510-287-5732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-08
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC6741171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist