Provider Demographics
NPI:1417157017
Name:HAGGERTY, NATALIE A (LAC)
Entity type:Individual
Prefix:MISS
First Name:NATALIE
Middle Name:A
Last Name:HAGGERTY
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:MISS
Other - First Name:NAT
Other - Middle Name:
Other - Last Name:HAGGERTY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC
Mailing Address - Street 1:1299 4TH ST
Mailing Address - Street 2:SUITE 406
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-3040
Mailing Address - Country:US
Mailing Address - Phone:415-235-2395
Mailing Address - Fax:
Practice Address - Street 1:1299 4TH ST
Practice Address - Street 2:SUITE 406
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-3040
Practice Address - Country:US
Practice Address - Phone:415-235-2395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-21
Last Update Date:2007-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9059171100000X
CA018357171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA018357OtherDIPL.AC.(NCCAOM)