Provider Demographics
NPI:1700939899
Name:OBERMAN, GLENN (LAC)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:
Last Name:OBERMAN
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 1:2006 DWIGHT WAY
Mailing Address - Street 2:SUITE 208
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-2633
Mailing Address - Country:US
Mailing Address - Phone:510-649-1560
Mailing Address - Fax:510-649-1560
Practice Address - Street 1:2006 DWIGHT WAY
Practice Address - Street 2:SUITE 208
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-2633
Practice Address - Country:US
Practice Address - Phone:510-649-1560
Practice Address - Fax:510-649-1560
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 2351171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist