Provider Demographics
NPI:1750503926
Name:TOVEG, MIRIAM (LAC)
Entity Type:Individual
Prefix:MS
First Name:MIRIAM
Middle Name:
Last Name:TOVEG
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:MS
Other - First Name:MIRIA
Other - Middle Name:M
Other - Last Name:TOVEG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC
Mailing Address - Street 1:1085 VALENCIA STREETSAN FRANCISCO
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110
Mailing Address - Country:US
Mailing Address - Phone:415-821-3634
Mailing Address - Fax:415-821-5830
Practice Address - Street 1:1085 VALENCIA STREETSAN FRANCISCO
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94134
Practice Address - Country:US
Practice Address - Phone:415-821-3634
Practice Address - Fax:415-821-5830
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 4496171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist