Provider Demographics
NPI:1891876421
Name:MARAVELL, CONSTANCE ZINNIA (L AC)
Entity Type:Individual
Prefix:MS
First Name:CONSTANCE
Middle Name:ZINNIA
Last Name:MARAVELL
Suffix:
Gender:F
Credentials:L AC
Other - Prefix:MS
Other - First Name:C
Other - Middle Name:ZINNIA
Other - Last Name:MARAVELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:L AC
Mailing Address - Street 1:3238 RODMAN ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20008-3113
Mailing Address - Country:US
Mailing Address - Phone:202-362-0745
Mailing Address - Fax:
Practice Address - Street 1:3238 RODMAN ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008-3113
Practice Address - Country:US
Practice Address - Phone:202-362-0745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCAC30076171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist