Healthcare Provider Details

I. General information

NPI: 1548607468
Provider Name (Legal Business Name): LISA MARIE SANCHEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2013
Last Update Date: 06/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 CORINTH AVE SUITE 211
LOS ANGELES CA
90064-1650
US

IV. Provider business mailing address

2211 CORINTH AVE SUITE 211
LOS ANGELES CA
90064-1650
US

V. Phone/Fax

Practice location:
  • Phone: 310-614-5147
  • Fax:
Mailing address:
  • Phone: 310-614-5147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number8308
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: