Healthcare Provider Details

I. General information

NPI: 1194087338
Provider Name (Legal Business Name): SARAH LEANN ADCOCK L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2012
Last Update Date: 06/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 S HUDSON AVE SUITE 4
PASADENA CA
91101-2614
US

IV. Provider business mailing address

133 S HUDSON AVE SUITE 4
PASADENA CA
91101-2614
US

V. Phone/Fax

Practice location:
  • Phone: 626-449-5511
  • Fax:
Mailing address:
  • Phone: 626-449-5511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number14272
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: