Provider Demographics
NPI:1982041794
Name:TARRADELLES, CHRISTINE (LAC)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:
Last Name:TARRADELLES
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:MRS
Other - First Name:CHRISTINE
Other - Middle Name:TARRADELLES
Other - Last Name:NEWELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC
Mailing Address - Street 1:32 FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-2314
Mailing Address - Country:US
Mailing Address - Phone:510-409-0145
Mailing Address - Fax:510-524-0145
Practice Address - Street 1:907 IRWIN ST
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-3317
Practice Address - Country:US
Practice Address - Phone:510-409-0145
Practice Address - Fax:510-524-0145
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-03
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5583171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist