Provider Demographics
NPI:1982363701
Name:SHARRON SAN MARTINO ACUPUNCTURE, LLC
Entity Type:Organization
Organization Name:SHARRON SAN MARTINO ACUPUNCTURE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARRON
Authorized Official - Middle Name:
Authorized Official - Last Name:SAN MARTINO
Authorized Official - Suffix:
Authorized Official - Credentials:AEMP, LAC
Authorized Official - Phone:206-451-4560
Mailing Address - Street 1:10285 NE BARKENTINE RD
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE IS
Mailing Address - State:WA
Mailing Address - Zip Code:98110-3714
Mailing Address - Country:US
Mailing Address - Phone:206-451-4560
Mailing Address - Fax:
Practice Address - Street 1:5355 WELFARE AVE NE
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-3179
Practice Address - Country:US
Practice Address - Phone:310-463-3466
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-08
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAC61201713OtherSTATE OF WA ACUPUNCTURE LICENSE
WA1962168617OtherNPPES