Provider Demographics
NPI:1265612436
Name:REIFF, EVAN SHEPHERD (LAC)
Entity type:Individual
Prefix:MR
First Name:EVAN
Middle Name:SHEPHERD
Last Name:REIFF
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:MR
Other - First Name:EVAN
Other - Middle Name:JAY
Other - Last Name:SHEPHERD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:38 CALEDONIA ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SAUSALITO
Mailing Address - State:CA
Mailing Address - Zip Code:94965-2117
Mailing Address - Country:US
Mailing Address - Phone:415-670-9580
Mailing Address - Fax:
Practice Address - Street 1:38 CALEDONIA ST
Practice Address - Street 2:SUITE 1
Practice Address - City:SAUSALITO
Practice Address - State:CA
Practice Address - Zip Code:94965-2117
Practice Address - Country:US
Practice Address - Phone:415-670-9580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-06
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC7818171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist