Provider Demographics
NPI:1942772090
Name:BIRD, WHITNEY JACQUELINE (LAC, DACM)
Entity Type:Individual
Prefix:
First Name:WHITNEY
Middle Name:JACQUELINE
Last Name:BIRD
Suffix:
Gender:F
Credentials:LAC, DACM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4444 REDWOOD RD
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-9709
Mailing Address - Country:US
Mailing Address - Phone:415-450-5182
Mailing Address - Fax:
Practice Address - Street 1:147 LOMITA DR STE C
Practice Address - Street 2:
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-1462
Practice Address - Country:US
Practice Address - Phone:415-450-5182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-28
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18305171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist