Healthcare Provider Details

I. General information

NPI: 1487981148
Provider Name (Legal Business Name): LUCINDA ROSE KOTTER L.AC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2009
Last Update Date: 04/26/2025
Certification Date: 04/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 MARCH AVE STE A
HEALDSBURG CA
95448-3387
US

IV. Provider business mailing address

PO BOX 1690
HEALDSBURG CA
95448-1690
US

V. Phone/Fax

Practice location:
  • Phone: 707-239-1687
  • Fax:
Mailing address:
  • Phone: 707-239-1687
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number9872
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: