Healthcare Provider Details

I. General information

NPI: 1477904027
Provider Name (Legal Business Name): LORI STEPHENS LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2016
Last Update Date: 06/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 W BEECH ST STE 202
FALLBROOK CA
92028-2906
US

IV. Provider business mailing address

4155 SERRANOS CT
FALLBROOK CA
92028-9466
US

V. Phone/Fax

Practice location:
  • Phone: 714-330-9244
  • Fax:
Mailing address:
  • Phone: 714-330-9244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number15042
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: