Provider Demographics
NPI:1073659728
Name:LYONS, C SAMANTHA (LAC 1060)
Entity Type:Individual
Prefix:
First Name:C SAMANTHA
Middle Name:
Last Name:LYONS
Suffix:
Gender:F
Credentials:LAC 1060
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 CAMINO ALTO
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941
Mailing Address - Country:US
Mailing Address - Phone:415-721-7796
Mailing Address - Fax:
Practice Address - Street 1:61 CAMINO ALTO
Practice Address - Street 2:SUITE 104
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941
Practice Address - Country:US
Practice Address - Phone:415-721-7796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC1060171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist