Provider Demographics
NPI:1952520850
Name:MAYNES, JOHN V (LAC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:V
Last Name:MAYNES
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2320 PRINCE ST
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-1916
Mailing Address - Country:US
Mailing Address - Phone:510-843-7370
Mailing Address - Fax:510-843-7379
Practice Address - Street 1:2320 PRINCE ST
Practice Address - Street 2:SUITE 100
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-1916
Practice Address - Country:US
Practice Address - Phone:510-843-7370
Practice Address - Fax:510-843-7379
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6843171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist