Provider Demographics
NPI:1063558716
Name:CRAWFORD, MARTHA (LAC)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:290 STUYVESANT DRIVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANSELMO
Mailing Address - State:CA
Mailing Address - Zip Code:94960-1144
Mailing Address - Country:US
Mailing Address - Phone:415-453-7796
Mailing Address - Fax:415-453-6610
Practice Address - Street 1:61 CAMINO ALTO
Practice Address - Street 2:SUITE 104
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-2910
Practice Address - Country:US
Practice Address - Phone:415-388-8225
Practice Address - Fax:415-388-5115
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC4253171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist