Healthcare Provider Details

I. General information

NPI: 1992500995
Provider Name (Legal Business Name): PEACEFUL PROVIDER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2025
Last Update Date: 01/12/2026
Certification Date: 01/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1818 LA PLZ STE 104
COTATI CA
94931-5216
US

IV. Provider business mailing address

1818 LA PLZ STE 104
COTATI CA
94931-5216
US

V. Phone/Fax

Practice location:
  • Phone: 707-634-4487
  • Fax:
Mailing address:
  • Phone: 707-634-4487
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: DEMETRA MARKIS
Title or Position: CEO
Credential: LAC
Phone: 707-634-4487