Provider Demographics
NPI:1639321136
Name:CUSHNIR, EMMY CUSHNIR KATHLEEN (LAC)
Entity Type:Individual
Prefix:
First Name:EMMY CUSHNIR
Middle Name:KATHLEEN
Last Name:CUSHNIR
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 1:626 FREDERICK ST
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-2203
Mailing Address - Country:US
Mailing Address - Phone:831-234-3199
Mailing Address - Fax:831-462-3227
Practice Address - Street 1:626 FREDERICK ST
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95062-2203
Practice Address - Country:US
Practice Address - Phone:831-234-3199
Practice Address - Fax:831-462-3227
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-15
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4509171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist