Provider Demographics
NPI:1306589056
Name:ORTON, NICOLE M (LAC)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:M
Last Name:ORTON
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:ELOKIN
Other - Middle Name:
Other - Last Name:ORTON-CHEUNG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:585 9TH ST UNIT 358
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-3827
Mailing Address - Country:US
Mailing Address - Phone:510-990-1239
Mailing Address - Fax:
Practice Address - Street 1:440 GRAND AVE STE 401
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-5032
Practice Address - Country:US
Practice Address - Phone:510-990-1239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-19
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19276171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist