Provider Demographics
NPI:1437579984
Name:LISZT, KERRY GINIE (LAC)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:GINIE
Last Name:LISZT
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 1:201 LAGUNA ST
Mailing Address - Street 2:#8
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-5668
Mailing Address - Country:US
Mailing Address - Phone:415-827-1445
Mailing Address - Fax:
Practice Address - Street 1:2409 SACRAMENTO ST
Practice Address - Street 2:SUITE 2
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-2225
Practice Address - Country:US
Practice Address - Phone:415-827-1445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-23
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15020171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist