Provider Demographics
NPI:1205984663
Name:PLASTINO, JOAN MADELEINE (LAC)
Entity type:Individual
Prefix:MS
First Name:JOAN
Middle Name:MADELEINE
Last Name:PLASTINO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:720 SOUTHPOINT BLVD STE 211
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954-7496
Mailing Address - Country:US
Mailing Address - Phone:707-981-7015
Mailing Address - Fax:707-658-1649
Practice Address - Street 1:4096 BRIDGE ST STE 3
Practice Address - Street 2:
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-7160
Practice Address - Country:US
Practice Address - Phone:916-962-1000
Practice Address - Fax:916-961-0251
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3123171100000X
DC003332171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist