Healthcare Provider Details

I. General information

NPI: 1497108146
Provider Name (Legal Business Name): TLC MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2016
Last Update Date: 07/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 MILLER AVE SUITE 204
MILL VALLEY CA
94941-1931
US

IV. Provider business mailing address

74 BILLOU ST
SAN RAFAEL CA
94901-5101
US

V. Phone/Fax

Practice location:
  • Phone: 415-758-1682
  • Fax: 415-590-3953
Mailing address:
  • Phone: 510-206-9323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC15612
License Number StateCA

VIII. Authorized Official

Name: TERESA LAU
Title or Position: SOLE PROPRIETOR
Credential: L.AC.
Phone: 415-758-1682