Provider Demographics
NPI:1497185870
Name:MAXEY, KATE (LAC)
Entity Type:Individual
Prefix:
First Name:KATE
Middle Name:
Last Name:MAXEY
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 1:225 FELL ST APT 14
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-5160
Mailing Address - Country:US
Mailing Address - Phone:415-335-0282
Mailing Address - Fax:
Practice Address - Street 1:225 FELL ST APT 14
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-5160
Practice Address - Country:US
Practice Address - Phone:415-335-0282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-20
Last Update Date:2013-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC13554171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist