Provider Demographics
NPI:1912265083
Name:PARKER, NATHAN (LAC)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:
Last Name:PARKER
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 1:839 59TH ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94608-1407
Mailing Address - Country:US
Mailing Address - Phone:415-717-5778
Mailing Address - Fax:
Practice Address - Street 1:839 59TH ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94608-1407
Practice Address - Country:US
Practice Address - Phone:415-717-5778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-26
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC14756171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist