Provider Demographics
NPI:1174741144
Name:HIRABAYASHI, LYNETTE O'BRIEN (LAC)
Entity type:Individual
Prefix:MS
First Name:LYNETTE
Middle Name:O'BRIEN
Last Name:HIRABAYASHI
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 1:277 LOS ANGELES BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN ANSELMO
Mailing Address - State:CA
Mailing Address - Zip Code:94960-1608
Mailing Address - Country:US
Mailing Address - Phone:415-454-9098
Mailing Address - Fax:
Practice Address - Street 1:908 E ST
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-2851
Practice Address - Country:US
Practice Address - Phone:415-307-4747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC7993171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist