Provider Demographics
NPI:1225776883
Name:STEWART, ERIN M (LAC)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:M
Last Name:STEWART
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2820 HEATHERSTONE DR
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-1410
Mailing Address - Country:US
Mailing Address - Phone:415-902-0228
Mailing Address - Fax:
Practice Address - Street 1:25 EVERGREEN AVE STE 2A
Practice Address - Street 2:
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-3399
Practice Address - Country:US
Practice Address - Phone:415-902-0228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-24
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19334171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty