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General NPI Number Information
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NPI Number | 1972719003
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Entity Type | Individual
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Provider Name | CONSTANCE PRODROMOU L.AC.
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Gender | Female
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 02/14/2012
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Provider Practice Location Address
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Address Line | 710 C ST SUITE 210
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City | SAN RAFAEL
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State | CA
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Zip | 94901-3857
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Country | US
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Telephone | 415-485-1639
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Fax | 415-485-0103
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Provider Business Mailing Address
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Address Line | 710 C ST SUITE 210
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City | SAN RAFAEL
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State | CA
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Zip | 94901-3857
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Country | US
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Telephone | 415-485-1639
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Fax | 415-485-0103
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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 | CA 6956
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License Number State | CA
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