Provider Demographics
NPI:1710123583
Name:ZOLLINGER, TRACY ANN (LAC)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:ANN
Last Name:ZOLLINGER
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 1:2424 BLANDING AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-1553
Mailing Address - Country:US
Mailing Address - Phone:510-299-0057
Mailing Address - Fax:
Practice Address - Street 1:2424 BLANDING AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-1553
Practice Address - Country:US
Practice Address - Phone:510-299-0057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-29
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC12380171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist