Provider Demographics
NPI:1104485283
Name:ADKINS, GRAZINA (DOM)
Entity type:Individual
Prefix:
First Name:GRAZINA
Middle Name:
Last Name:ADKINS
Suffix:
Gender:F
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2831 SEVENTH ST
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94710-2702
Mailing Address - Country:US
Mailing Address - Phone:510-863-0333
Mailing Address - Fax:
Practice Address - Street 1:2831 SEVENTH ST
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94710-2702
Practice Address - Country:US
Practice Address - Phone:510-863-0333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-11
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6910171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist