Healthcare Provider Details

I. General information

NPI: 1275990350
Provider Name (Legal Business Name): DAFNA LAURIE, LAC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2016
Last Update Date: 03/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 S ARROYO PKWY
PASADENA CA
91105-2519
US

IV. Provider business mailing address

501 S ARROYO PKWY
PASADENA CA
91105-2519
US

V. Phone/Fax

Practice location:
  • Phone: 310-853-0709
  • Fax:
Mailing address:
  • Phone: 310-853-0709
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number13523
License Number StateCA

VIII. Authorized Official

Name: MS. DAFNA LAURIE
Title or Position: OWNER
Credential: L.AC.
Phone: 310-853-0709