Provider Demographics
NPI:1407033897
Name:CORWIN, MARIE ELIZABETH (LAC)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:ELIZABETH
Last Name:CORWIN
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 1:21615 E CLIFF DR
Mailing Address - Street 2:#3
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-4951
Mailing Address - Country:US
Mailing Address - Phone:831-359-7197
Mailing Address - Fax:
Practice Address - Street 1:108 LOCUST ST
Practice Address - Street 2:SUITE 2
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-3930
Practice Address - Country:US
Practice Address - Phone:831-359-2374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-28
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 10944171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist