Provider Demographics
NPI:1740785682
Name:VARLACK, AUGUST-G (LAC, DAOM)
Entity Type:Individual
Prefix:
First Name:AUGUST-G
Middle Name:
Last Name:VARLACK
Suffix:
Gender:M
Credentials:LAC, DAOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10783
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-0783
Mailing Address - Country:US
Mailing Address - Phone:510-379-8910
Mailing Address - Fax:
Practice Address - Street 1:9 GRAND AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-3727
Practice Address - Country:US
Practice Address - Phone:510-379-8910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-23
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13955171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty