Provider Demographics
NPI:1154725539
Name:MOREN, TRACI VOGEL (LAC)
Entity type:Individual
Prefix:
First Name:TRACI
Middle Name:VOGEL
Last Name:MOREN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 SPAULDING AVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94703-1628
Mailing Address - Country:US
Mailing Address - Phone:415-235-5092
Mailing Address - Fax:
Practice Address - Street 1:2300 SPAULDING AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94703-1628
Practice Address - Country:US
Practice Address - Phone:415-235-5092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-14
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16248171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist