Provider Demographics
NPI:1497516033
Name:MCGARRY, KATHLEEN (LAC)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:MCGARRY
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 1:1299 4TH ST STE 308
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-3029
Mailing Address - Country:US
Mailing Address - Phone:415-717-9088
Mailing Address - Fax:
Practice Address - Street 1:1299 4TH ST STE 308
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-3029
Practice Address - Country:US
Practice Address - Phone:415-717-9088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11993171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist