Provider Demographics
NPI:1275786881
Name:PAPE, ANTHONY (LAC)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:PAPE
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 PARK VIEW TER APT 308
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-4672
Mailing Address - Country:US
Mailing Address - Phone:510-663-5908
Mailing Address - Fax:
Practice Address - Street 1:3300 WEBSTER ST STE 408
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3149
Practice Address - Country:US
Practice Address - Phone:510-444-2772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12537171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist