Provider Demographics
NPI:1407169790
Name:NORTON, MARY (LAC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:NORTON
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 1:200 BROADWAY BLVD
Mailing Address - Street 2:STE. 101
Mailing Address - City:FAIRFAX
Mailing Address - State:CA
Mailing Address - Zip Code:94930-1569
Mailing Address - Country:US
Mailing Address - Phone:415-460-0789
Mailing Address - Fax:
Practice Address - Street 1:200 BROADWAY BLVD
Practice Address - Street 2:STE.101
Practice Address - City:FAIRFAX
Practice Address - State:CA
Practice Address - Zip Code:94930-1569
Practice Address - Country:US
Practice Address - Phone:415-460-0789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-15
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4635171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist