Healthcare Provider Details

I. General information

NPI: 1124109574
Provider Name (Legal Business Name): GINA A HABER LAC DNBAO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 N LAKE AVENUE
PASADENA CA
91104
US

IV. Provider business mailing address

16200 E AMBER VALLEY DRIVE
WHITTIER CA
90604
US

V. Phone/Fax

Practice location:
  • Phone: 626-798-7805
  • Fax: 626-791-8960
Mailing address:
  • Phone: 562-947-8755
  • Fax: 562-902-3332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC8260
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: