Provider Demographics
NPI:1750893442
Name:MAYOFF, DEBRA SHARI (LAC)
Entity type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:SHARI
Last Name:MAYOFF
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 1:215 TREVETHAN AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-1201
Mailing Address - Country:US
Mailing Address - Phone:831-431-7669
Mailing Address - Fax:
Practice Address - Street 1:2222 E CLIFF DR STE 216
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95062-4739
Practice Address - Country:US
Practice Address - Phone:831-431-7669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-02
Last Update Date:2017-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12058171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty