Provider Demographics
NPI:1699828269
Name:RAKELA, NANCY (LAC)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:RAKELA
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 1:2228 6TH ST
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94710-2219
Mailing Address - Country:US
Mailing Address - Phone:510-540-6267
Mailing Address - Fax:510-540-6212
Practice Address - Street 1:2228 6TH ST
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94710-2219
Practice Address - Country:US
Practice Address - Phone:510-540-6267
Practice Address - Fax:510-540-6212
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC2574171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist