Provider Demographics
NPI:1720450265
Name:WEISBERG, ELANA (BFA, MSOM, LAC)
Entity Type:Individual
Prefix:
First Name:ELANA
Middle Name:
Last Name:WEISBERG
Suffix:
Gender:F
Credentials:BFA, MSOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1646 PRINCE STREET
Mailing Address - Street 2:APT B
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94703-2462
Mailing Address - Country:US
Mailing Address - Phone:412-418-2219
Mailing Address - Fax:
Practice Address - Street 1:1646 PRINCE STREET
Practice Address - Street 2:APT B
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94703-2462
Practice Address - Country:US
Practice Address - Phone:412-418-2219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-23
Last Update Date:2015-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16730171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist