Provider Demographics
NPI:1366714065
Name:ELFVING, CAITLIN (LAC)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:
Last Name:ELFVING
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:CAITLIN
Other - Middle Name:
Other - Last Name:SORENSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:1010 FAIR AVE STE D
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-5860
Mailing Address - Country:US
Mailing Address - Phone:831-425-1383
Mailing Address - Fax:
Practice Address - Street 1:1010 FAIR AVE STE D
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-5860
Practice Address - Country:US
Practice Address - Phone:831-425-1383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-27
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13952171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist