Healthcare Provider Details

I. General information

NPI: 1386282465
Provider Name (Legal Business Name): DEMETRA MARKIS LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2019
Last Update Date: 01/12/2026
Certification Date: 01/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1818 LA PLZ
COTATI CA
94931-5209
US

IV. Provider business mailing address

1250 BIG BARN RD
CAZADERO CA
95421-9624
US

V. Phone/Fax

Practice location:
  • Phone: 707-534-4487
  • Fax:
Mailing address:
  • Phone: 415-710-7363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number13328
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: