Provider Demographics
NPI:1891066361
Name:COYOTE, MICHIEL (LAC, CMT)
Entity type:Individual
Prefix:MR
First Name:MICHIEL
Middle Name:
Last Name:COYOTE
Suffix:
Gender:M
Credentials:LAC, CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:CA
Mailing Address - Zip Code:94930-1708
Mailing Address - Country:US
Mailing Address - Phone:415-342-3533
Mailing Address - Fax:
Practice Address - Street 1:751 CENTER BLVD
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:CA
Practice Address - Zip Code:94930-1764
Practice Address - Country:US
Practice Address - Phone:415-419-5397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-15
Last Update Date:2012-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 13658171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist