Healthcare Provider Details

I. General information

NPI: 1174741144
Provider Name (Legal Business Name): LYNETTE O'BRIEN HIRABAYASHI L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

908 E ST
SAN RAFAEL CA
94901-2851
US

IV. Provider business mailing address

277 LOS ANGELES BLVD
SAN ANSELMO CA
94960-1608
US

V. Phone/Fax

Practice location:
  • Phone: 415-307-4747
  • Fax:
Mailing address:
  • Phone: 415-454-9098
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC7993
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: