Provider Demographics
NPI:1508900986
Name:SCARAN, MARY (L AC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:SCARAN
Suffix:
Gender:F
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 STATE ST
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101-2573
Mailing Address - Country:US
Mailing Address - Phone:805-563-9977
Mailing Address - Fax:805-898-1404
Practice Address - Street 1:1725 STATE ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-2573
Practice Address - Country:US
Practice Address - Phone:805-563-9977
Practice Address - Fax:805-898-1404
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC3918171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC3918OtherACUPUNCTURE LICENSE NUMBE
CAAC0039180Medicaid