Healthcare Provider Details

I. General information

NPI: 1497530760
Provider Name (Legal Business Name): LAUREN SARA CIVELLO L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2023
Last Update Date: 08/25/2023
Certification Date: 08/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17525 VENTURA BLVD STE 108
ENCINO CA
91316-5106
US

IV. Provider business mailing address

17525 VENTURA BLVD STE 108
ENCINO CA
91316-5106
US

V. Phone/Fax

Practice location:
  • Phone: 818-817-0049
  • Fax: 818-817-0958
Mailing address:
  • Phone: 818-817-0049
  • Fax: 818-817-0958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number10500
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: