Active NPI
Constance Prodromou, L.AC.
- Acupuncturist
- San Rafael, CA
National Provider Identifier
1972719003
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Acupuncturist
- License
- CA 6956
- Practice address
- 710 C St
Suite 210
San Rafael, CA 94901-3857 - Phone
- (415) 485-1639
- Fax
- (415) 485-0103
- NPI assigned
- May 15, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Acupuncturist | 171100000X | CA 6956 | CA | Primary |
Addresses
Primary practice location
710 C St
Suite 210
San Rafael, CA 94901-3857
Mailing address
710 C St
Suite 210
San Rafael, CA 94901-3857
Phone (415) 485-1639
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CA 6956 | CA | MD | Acupuncturist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179187200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1329177600000",
"number": "1972719003",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "710 C ST",
"address_2": "SUITE 210",
"city": "SAN RAFAEL",
"state": "CA",
"postal_code": "949013857",
"telephone_number": "415-485-1639",
"fax_number": "415-485-0103"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "710 C ST",
"address_2": "SUITE 210",
"city": "SAN RAFAEL",
"state": "CA",
"postal_code": "949013857",
"telephone_number": "415-485-1639",
"fax_number": "415-485-0103"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PRODROMOU",
"first_name": "CONSTANCE",
"name_prefix": "Ms.",
"credential": "L.AC.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-05-15",
"last_updated": "2012-02-14",
"status": "A"
},
"taxonomies": [
{
"code": "171100000X",
"taxonomy_group": "",
"desc": "Acupuncturist",
"state": "CA",
"license": "CA 6956",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Rafael, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.