Provider Demographics
NPI:1962775171
Name:STRAEHLEY, MARCIA (LAC)
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:
Last Name:STRAEHLEY
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:MARCIA
Other - Middle Name:
Other - Last Name:STONE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC
Mailing Address - Street 1:810 SAN LUIS RD
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94707-2053
Mailing Address - Country:US
Mailing Address - Phone:510-295-3630
Mailing Address - Fax:510-527-5080
Practice Address - Street 1:810 SAN LUIS RD
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94707-2053
Practice Address - Country:US
Practice Address - Phone:510-295-3630
Practice Address - Fax:510-527-5080
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-17
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC12173171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist