Healthcare Provider Details

I. General information

NPI: 1164880688
Provider Name (Legal Business Name): MELISSA GELIN LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2016
Last Update Date: 01/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9053 SOQUEL DR SUITE A
APTOS CA
95003-4034
US

IV. Provider business mailing address

PO BOX 1771
APTOS CA
95001-1771
US

V. Phone/Fax

Practice location:
  • Phone: 831-239-6141
  • Fax: 831-851-3502
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC 16894
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: