Provider Demographics
NPI:1710636683
Name:PETERS, ERIN K (DTCM, LAC)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:K
Last Name:PETERS
Suffix:
Gender:F
Credentials:DTCM, LAC
Other - Prefix:
Other - First Name:ARUNA
Other - Middle Name:
Other - Last Name:PETERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DTCM, LAC
Mailing Address - Street 1:184 EL SOLYO HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:FELTON
Mailing Address - State:CA
Mailing Address - Zip Code:95018-9305
Mailing Address - Country:US
Mailing Address - Phone:831-428-2820
Mailing Address - Fax:
Practice Address - Street 1:15951 LOS GATOS BLVD STE 15
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-3488
Practice Address - Country:US
Practice Address - Phone:408-389-8840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-19
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC19129171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty