Provider Demographics
NPI:1497108146
Name:TLC MEDICINE
Entity Type:Organization
Organization Name:TLC MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAU
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:415-758-1682
Mailing Address - Street 1:74 BILLOU ST
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-5101
Mailing Address - Country:US
Mailing Address - Phone:510-206-9323
Mailing Address - Fax:
Practice Address - Street 1:16 MILLER AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-1931
Practice Address - Country:US
Practice Address - Phone:415-758-1682
Practice Address - Fax:415-590-3953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-18
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC15612171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty