Healthcare Provider Details

I. General information

NPI: 1427318419
Provider Name (Legal Business Name): PETER H FAIRFIELD LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2012
Last Update Date: 05/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 CAMINO ALTO SUITE G
MILL VALLEY CA
94941-2254
US

IV. Provider business mailing address

131 CAMINO ALTO SUITE G
MILL VALLEY CA
94941-2254
US

V. Phone/Fax

Practice location:
  • Phone: 415-377-0862
  • Fax:
Mailing address:
  • Phone: 415-377-0862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC1278
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: