Provider Demographics
NPI:1538229232
Name:BERNSTEIN, MARILYN BETH (LAC)
Entity type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:BETH
Last Name:BERNSTEIN
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 1:912 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-3808
Mailing Address - Country:US
Mailing Address - Phone:831-426-6482
Mailing Address - Fax:831-429-0103
Practice Address - Street 1:912 CENTER ST
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-3808
Practice Address - Country:US
Practice Address - Phone:831-426-6482
Practice Address - Fax:831-429-0103
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 3221171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC3221OtherACUPUNCTURE LICENSE