Provider Demographics
NPI:1114229028
Name:FREEMAN, CONDE C (LAC)
Entity Type:Individual
Prefix:
First Name:CONDE
Middle Name:C
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:CONDICT
Other - Middle Name:C
Other - Last Name:FREEMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC
Mailing Address - Street 1:131 CAMINO ALTO
Mailing Address - Street 2:SUITE G
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-2254
Mailing Address - Country:US
Mailing Address - Phone:415-686-7615
Mailing Address - Fax:
Practice Address - Street 1:131 CAMINO ALTO
Practice Address - Street 2:SUITE G
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-2254
Practice Address - Country:US
Practice Address - Phone:415-686-7615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-29
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA13239171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist