Provider Demographics
NPI:1609269455
Name:MALONEY, AMY (LAC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:MALONEY
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:AME
Other - Middle Name:M
Other - Last Name:MALONEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC
Mailing Address - Street 1:858 YORK ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-2843
Mailing Address - Country:US
Mailing Address - Phone:415-902-0236
Mailing Address - Fax:
Practice Address - Street 1:406 CORTLAND AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-5538
Practice Address - Country:US
Practice Address - Phone:415-550-8444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-17
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7635171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist