Provider Demographics
NPI:1942538228
Name:LUSTMAN HIRSCH, KATHLEEN (CA, LICAC)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:
Last Name:LUSTMAN HIRSCH
Suffix:
Gender:F
Credentials:CA, LICAC
Other - Prefix:MS
Other - First Name:KATHLEEN
Other - Middle Name:
Other - Last Name:LUSTMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CA,LICAC
Mailing Address - Street 1:366 VIA HIDALGO
Mailing Address - Street 2:
Mailing Address - City:GREENBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94904-1801
Mailing Address - Country:US
Mailing Address - Phone:415-258-0950
Mailing Address - Fax:
Practice Address - Street 1:366 VIA HIDALGO
Practice Address - Street 2:
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904-1801
Practice Address - Country:US
Practice Address - Phone:415-258-0950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-25
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC1304171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist