Provider Demographics
NPI:1518090158
Name:HIMMEL, RAYMOND (LAC, OMD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:
Last Name:HIMMEL
Suffix:
Gender:M
Credentials:LAC, OMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 LOMITA DR STE C
Mailing Address - Street 2:
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-1462
Mailing Address - Country:US
Mailing Address - Phone:415-383-7730
Mailing Address - Fax:
Practice Address - Street 1:147 LOMITA DR STE C
Practice Address - Street 2:
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-1462
Practice Address - Country:US
Practice Address - Phone:415-383-7730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC733171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist