Provider Demographics
NPI:1760755698
Name:TEWKSBURY, MARINTHA (LAC)
Entity Type:Individual
Prefix:
First Name:MARINTHA
Middle Name:
Last Name:TEWKSBURY
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 1:605 CHENERY ST
Mailing Address - Street 2:SUITES B & C
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94131-3033
Mailing Address - Country:US
Mailing Address - Phone:415-695-9513
Mailing Address - Fax:
Practice Address - Street 1:605 CHENERY ST
Practice Address - Street 2:SUITES B & C
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94131-3033
Practice Address - Country:US
Practice Address - Phone:415-695-9513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-23
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4694171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist