Healthcare Provider Details

I. General information

NPI: 1659796464
Provider Name (Legal Business Name): COREEN ELIZABETH LAMARK L.AC. L.AC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2014
Last Update Date: 05/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1097 E MAIN ST STE A
GRASS VALLEY CA
95945-5718
US

IV. Provider business mailing address

111 BANK ST # 138
GRASS VALLEY CA
95945-6518
US

V. Phone/Fax

Practice location:
  • Phone: 530-448-3613
  • Fax:
Mailing address:
  • Phone: 530-448-3613
  • Fax: 530-470-9163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC14820
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: