Provider Demographics
NPI:1669753414
Name:CLAIBORNE, DEIRDRA JOY (LAC)
Entity type:Individual
Prefix:MRS
First Name:DEIRDRA
Middle Name:JOY
Last Name:CLAIBORNE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:824 5TH AVENUE
Mailing Address - Street 2:SUITE C
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901
Mailing Address - Country:US
Mailing Address - Phone:415-485-5834
Mailing Address - Fax:415-456-2636
Practice Address - Street 1:824 5TH AVENUE
Practice Address - Street 2:SUITE C
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901
Practice Address - Country:US
Practice Address - Phone:415-485-5834
Practice Address - Fax:415-456-2636
Is Sole Proprietor?:No
Enumeration Date:2011-09-07
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CACW1488171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist