Provider Demographics
NPI:1700909165
Name:ELBIN, MARLENE KAY (LAC)
Entity Type:Individual
Prefix:MS
First Name:MARLENE
Middle Name:KAY
Last Name:ELBIN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5824 MARSHALL ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94608-2616
Mailing Address - Country:US
Mailing Address - Phone:510-601-8233
Mailing Address - Fax:510-601-8233
Practice Address - Street 1:5824 MARSHALL ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94608-2616
Practice Address - Country:US
Practice Address - Phone:510-601-8233
Practice Address - Fax:510-601-8233
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 4471171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist