Healthcare Provider Details

I. General information

NPI: 1417060187
Provider Name (Legal Business Name): MARLIN PRESS L. AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 09/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 BRANSCOMB ROAD
LAYTONVILLE CA
95454
US

IV. Provider business mailing address

PO BOX 870
LAYTONVILLE CA
95454-0870
US

V. Phone/Fax

Practice location:
  • Phone: 707-984-6131
  • Fax: 707-984-7337
Mailing address:
  • Phone: 707-984-6131
  • Fax: 707-984-7337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number5148
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: