Healthcare Provider Details

I. General information

NPI: 1518090158
Provider Name (Legal Business Name): RAYMOND HIMMEL L.AC., O.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

147 LOMITA DR STE C
MILL VALLEY CA
94941-1462
US

IV. Provider business mailing address

147 LOMITA DR STE C
MILL VALLEY CA
94941-1462
US

V. Phone/Fax

Practice location:
  • Phone: 415-383-7730
  • Fax:
Mailing address:
  • Phone: 415-383-7730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC733
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: