Healthcare Provider Details

I. General information

NPI: 1265612436
Provider Name (Legal Business Name): EVAN SHEPHERD REIFF L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: EVAN JAY SHEPHERD L.AC.

II. Dates (important events)

Enumeration Date: 11/06/2007
Last Update Date: 04/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38 CALEDONIA ST SUITE 1
SAUSALITO CA
94965-2117
US

IV. Provider business mailing address

38 CALEDONIA ST SUITE 1
SAUSALITO CA
94965-2117
US

V. Phone/Fax

Practice location:
  • Phone: 415-670-9580
  • Fax:
Mailing address:
  • Phone: 415-670-9580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC7818
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: