Healthcare Provider Details

I. General information

NPI: 1477609980
Provider Name (Legal Business Name): MARIE SOUZON YEE OMD, L.AC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 ATLANTIC AVE STE 6
LONG BEACH CA
90807-2833
US

IV. Provider business mailing address

28004 RIDGEFOREST CT
RANCHO PALOS VERDES CA
90275-3267
US

V. Phone/Fax

Practice location:
  • Phone: 562-427-8971
  • Fax:
Mailing address:
  • Phone: 310-265-0261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC 7695
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: