Healthcare Provider Details

I. General information

NPI: 1174351514
Provider Name (Legal Business Name): CLAIRE BULLARD THOMPSON LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2024
Last Update Date: 07/25/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

336 S EUCLID AVE
PASADENA CA
91101-3125
US

IV. Provider business mailing address

401 S ARDMORE AVE APT 210
LOS ANGELES CA
90020-3242
US

V. Phone/Fax

Practice location:
  • Phone: 626-822-9699
  • Fax:
Mailing address:
  • Phone: 646-339-5439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number20088
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number48759
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: