Provider Demographics
NPI:1740350131
Name:POMIANOWSKI, MARK STEVEN (LAC)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:STEVEN
Last Name:POMIANOWSKI
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:MARK
Other - Middle Name:STEVEN
Other - Last Name:POMIANOWSKI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC
Mailing Address - Street 1:3518 QUINTARA ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94116-1015
Mailing Address - Country:US
Mailing Address - Phone:415-541-5076
Mailing Address - Fax:415-647-6222
Practice Address - Street 1:1193 VALENCIA ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-3026
Practice Address - Country:US
Practice Address - Phone:415-541-5076
Practice Address - Fax:415-647-6222
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4170171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4170OtherACUPUNCTURIST