Provider Demographics
NPI:1538222773
Name:SALAS MONTEIL, DIANE LOUISE (LAC)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:LOUISE
Last Name:SALAS MONTEIL
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:
Other - Last Name:MONTEIL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:447 MILLER AVE
Mailing Address - Street 2:SUITE C1
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-2962
Mailing Address - Country:US
Mailing Address - Phone:415-389-0330
Mailing Address - Fax:415-389-6990
Practice Address - Street 1:447 MILLER AVE
Practice Address - Street 2:SUITE C1
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-2962
Practice Address - Country:US
Practice Address - Phone:415-389-0330
Practice Address - Fax:415-389-6990
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC#3649171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist