Provider Demographics
NPI:1205257995
Name:MINERVINI, LYNN MARIA (LAC MSTOM)
Entity type:Individual
Prefix:MS
First Name:LYNN
Middle Name:MARIA
Last Name:MINERVINI
Suffix:
Gender:F
Credentials:LAC MSTOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2882
Mailing Address - Street 2:
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-5882
Mailing Address - Country:US
Mailing Address - Phone:914-391-2346
Mailing Address - Fax:
Practice Address - Street 1:12702 VIA CORTINA
Practice Address - Street 2:SUITE 100D
Practice Address - City:DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92014-3769
Practice Address - Country:US
Practice Address - Phone:914-391-2346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-23
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15663171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist