Provider Demographics
NPI:1407691512
Name:ROSENBERG, ANDREA RYAN (LAC)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:RYAN
Last Name:ROSENBERG
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:ANNIE
Other - Middle Name:R
Other - Last Name:ROSENBERG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC
Mailing Address - Street 1:11 E PIER
Mailing Address - Street 2:
Mailing Address - City:SAUSALITO
Mailing Address - State:CA
Mailing Address - Zip Code:94965-3141
Mailing Address - Country:US
Mailing Address - Phone:415-302-0714
Mailing Address - Fax:
Practice Address - Street 1:2258 SANTA CLARA AVE STE 1
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-4473
Practice Address - Country:US
Practice Address - Phone:510-814-6900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-28
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20080171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist