Healthcare Provider Details

I. General information

NPI: 1316065717
Provider Name (Legal Business Name): LISA ANGELA ESPARZA L.AC.,MASTERS, B.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LISA ANGELA WAGENSEIL MASTER, B.S. LAC

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 E GRAND AVE
ARROYO GRANDE CA
93420-2505
US

IV. Provider business mailing address

PO BOX 1840
PISMO BEACH CA
93448-1840
US

V. Phone/Fax

Practice location:
  • Phone: 805-710-6526
  • Fax: 805-481-5893
Mailing address:
  • Phone: 805-710-6526
  • Fax: 805-481-5893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC11534
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: