Provider Demographics
NPI:1316153489
Name:SHERWOOD, MARK MICHAEL (LICAC)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:MICHAEL
Last Name:SHERWOOD
Suffix:
Gender:M
Credentials:LICAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 W MISSION ST STE 5
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101-2426
Mailing Address - Country:US
Mailing Address - Phone:805-687-2077
Mailing Address - Fax:
Practice Address - Street 1:16 W MISSION ST STE 5
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-2426
Practice Address - Country:US
Practice Address - Phone:805-687-2077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2364171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist