Provider Demographics
NPI:1093965725
Name:MCGINLEY, PEARL (LAC)
Entity Type:Individual
Prefix:
First Name:PEARL
Middle Name:
Last Name:MCGINLEY
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:PEARL
Other - Middle Name:MCGINLEY
Other - Last Name:KINSELLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:PO BOX 255
Mailing Address - Street 2:
Mailing Address - City:REDWAY
Mailing Address - State:CA
Mailing Address - Zip Code:95560-0255
Mailing Address - Country:US
Mailing Address - Phone:707-223-2238
Mailing Address - Fax:
Practice Address - Street 1:3168 REDWOOD DR
Practice Address - Street 2:
Practice Address - City:REDWAY
Practice Address - State:CA
Practice Address - Zip Code:95560
Practice Address - Country:US
Practice Address - Phone:707-223-2238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-30
Last Update Date:2019-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 12687171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist