Healthcare Provider Details

I. General information

NPI: 1669901583
Provider Name (Legal Business Name): SHEILA MARIE CAMPBELL LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2017
Last Update Date: 06/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8907 WILSHIRE BLVD STE 270
BEVERLY HILLS CA
90211-1929
US

IV. Provider business mailing address

814 W KNOLL DR
WEST HOLLYWOOD CA
90069-4714
US

V. Phone/Fax

Practice location:
  • Phone: 858-220-6469
  • Fax:
Mailing address:
  • Phone: 310-770-0034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC17632
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: