Provider Demographics
NPI:1265739213
Name:DIMATTEO, EUGENIA F (LAC)
Entity type:Individual
Prefix:
First Name:EUGENIA
Middle Name:F
Last Name:DIMATTEO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:GIA
Other - Middle Name:
Other - Last Name:DIMATTEO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:8 HARTE AVE
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-5222
Mailing Address - Country:US
Mailing Address - Phone:415-246-7819
Mailing Address - Fax:415-578-2463
Practice Address - Street 1:8 HARTE AVE
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-5222
Practice Address - Country:US
Practice Address - Phone:415-246-7819
Practice Address - Fax:415-578-2463
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-26
Last Update Date:2011-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9906171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist