Provider Demographics
NPI:1487430039
Name:CARTACKI, STEVEN (LAC)
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:
Last Name:CARTACKI
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 HECTOR LN
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94949-6382
Mailing Address - Country:US
Mailing Address - Phone:484-948-9814
Mailing Address - Fax:
Practice Address - Street 1:712 D ST STE L
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-3706
Practice Address - Country:US
Practice Address - Phone:484-948-9814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-07
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19773171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist