Provider Demographics
NPI:1053766188
Name:EVAN SHEPHERD REIFF, L.AC.
Entity type:Organization
Organization Name:EVAN SHEPHERD REIFF, L.AC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EVAN
Authorized Official - Middle Name:SHEPHERD
Authorized Official - Last Name:REIFF
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:415-670-9580
Mailing Address - Street 1:38 CALEDONIA ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SAUSALITO
Mailing Address - State:CA
Mailing Address - Zip Code:94965-2117
Mailing Address - Country:US
Mailing Address - Phone:415-332-1013
Mailing Address - Fax:415-231-3086
Practice Address - Street 1:38 CALEDONIA ST
Practice Address - Street 2:SUITE 1
Practice Address - City:SAUSALITO
Practice Address - State:CA
Practice Address - Zip Code:94965-2117
Practice Address - Country:US
Practice Address - Phone:415-332-1013
Practice Address - Fax:415-231-3086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-26
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC7818171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty