Provider Demographics
NPI:1497888036
Name:LACARRUBBA, STEPHANIE (LAC RN)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:LACARRUBBA
Suffix:
Gender:F
Credentials:LAC RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 N EL CAMINO ROAD
Mailing Address - Street 2:#C
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401
Mailing Address - Country:US
Mailing Address - Phone:650-344-8499
Mailing Address - Fax:650-344-8499
Practice Address - Street 1:60 N EL CAMINO ROAD
Practice Address - Street 2:#C
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401
Practice Address - Country:US
Practice Address - Phone:650-344-8499
Practice Address - Fax:650-344-8499
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA309326163W00000X
CA5511171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No163W00000XNursing Service ProvidersRegistered Nurse