Provider Demographics
NPI:1215298963
Name:LINDELLI, SUZANNE C (LAC)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:C
Last Name:LINDELLI
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 1:159 TUNSTEAD AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANSELMO
Mailing Address - State:CA
Mailing Address - Zip Code:94960-2616
Mailing Address - Country:US
Mailing Address - Phone:415-459-5977
Mailing Address - Fax:
Practice Address - Street 1:159 TUNSTEAD AVE
Practice Address - Street 2:
Practice Address - City:SAN ANSELMO
Practice Address - State:CA
Practice Address - Zip Code:94960-2616
Practice Address - Country:US
Practice Address - Phone:415-459-5977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-30
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14628171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist