Provider Demographics
NPI:1427290782
Name:ROEPER, BETTINA (LAC)
Entity type:Individual
Prefix:MRS
First Name:BETTINA
Middle Name:
Last Name:ROEPER
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 1:119 DAY ST
Mailing Address - Street 2:101
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94131-2461
Mailing Address - Country:US
Mailing Address - Phone:415-200-7878
Mailing Address - Fax:
Practice Address - Street 1:2146 SUTTER ST
Practice Address - Street 2:B
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3120
Practice Address - Country:US
Practice Address - Phone:415-200-7878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-01
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 12840171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist