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General NPI Number Information
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NPI Number | 1689928681
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Entity Type | Individual
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Provider Name | MAUREEN MCMAHON HARTKER L.AC.
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Gender | Female
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Dates
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Enumeration Date | 10/30/2012
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Last Update Date | 12/23/2016
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Provider Practice Location Address
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Address Line | 3030 BRIDGEWAY SUITE 103
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City | SAUSALITO
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State | CA
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Zip | 94965-2810
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Country | US
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Telephone | 415-521-8133
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Fax |
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Provider Business Mailing Address
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Address Line | 124 GLEN DR
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City | SAUSALITO
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State | CA
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Zip | 94965-2029
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Country | US
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Telephone | 415-521-8133
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 14758
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License Number State | CA
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