Healthcare Provider Details

I. General information

NPI: 1568584027
Provider Name (Legal Business Name): MARIA SOCORRO LOCSIN L. AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARIA LOCSIN L. AC.

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 S BARRINGTON AVE SUITE 220
LOS ANGELES CA
90025-5363
US

IV. Provider business mailing address

2211 4TH ST APT. # 202
SANTA MONICA CA
90405-2357
US

V. Phone/Fax

Practice location:
  • Phone: 310-396-4195
  • Fax: 310-473-9767
Mailing address:
  • Phone: 310-396-4195
  • Fax: 310-473-9767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number9354
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: