Provider Demographics
NPI:1992188205
Name:ANTUNEZ, ERIN (LAC)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:ANTUNEZ
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 1:165 BEAVER ST APT 1
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94114-1550
Mailing Address - Country:US
Mailing Address - Phone:415-218-3215
Mailing Address - Fax:
Practice Address - Street 1:165 BEAVER ST APT 1
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94114-1550
Practice Address - Country:US
Practice Address - Phone:415-218-3215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-06
Last Update Date:2015-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12033171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist