Provider Demographics
NPI:1790083731
Name:FALK, BRIAN DANIEL (LAC MTCM)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:DANIEL
Last Name:FALK
Suffix:
Gender:M
Credentials:LAC MTCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 N CALLE CESAR CHAVEZ
Mailing Address - Street 2:110
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93103-3662
Mailing Address - Country:US
Mailing Address - Phone:805-223-0915
Mailing Address - Fax:
Practice Address - Street 1:1 N CALLE CESAR CHAVEZ
Practice Address - Street 2:110
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93103-3662
Practice Address - Country:US
Practice Address - Phone:805-223-0915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-28
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13729171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist