Provider Demographics
NPI:1811352859
Name:DABKOSKA, WANDA LAUREN EMIKO (LAC)
Entity type:Individual
Prefix:
First Name:WANDA LAUREN
Middle Name:EMIKO
Last Name:DABKOSKA
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:888 VERMONT ST
Mailing Address - Street 2:#311
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-2157
Mailing Address - Country:US
Mailing Address - Phone:510-459-0863
Mailing Address - Fax:
Practice Address - Street 1:339 15TH ST
Practice Address - Street 2:SUITE 333
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-3365
Practice Address - Country:US
Practice Address - Phone:510-922-0313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-17
Last Update Date:2016-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16822171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist