Provider Demographics
NPI:1811649023
Name:ROSENBERG, AMANDA LIORA (MSOM)
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:LIORA
Last Name:ROSENBERG
Suffix:
Gender:F
Credentials:MSOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:886 CLEVELAND ST APT 6
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94606-1535
Mailing Address - Country:US
Mailing Address - Phone:415-894-7888
Mailing Address - Fax:
Practice Address - Street 1:440 GRAND AVE FL 4
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-5029
Practice Address - Country:US
Practice Address - Phone:415-894-7888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-19
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14118171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist