Healthcare Provider Details

I. General information

NPI: 1891464285
Provider Name (Legal Business Name): CHRISTINA LEDOUX L.AC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2021
Last Update Date: 09/09/2021
Certification Date: 09/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 N RAYMOND AVE STE 811
PASADENA CA
91103-4480
US

IV. Provider business mailing address

88 E BAY STATE ST UNIT 3F
ALHAMBRA CA
91801-6824
US

V. Phone/Fax

Practice location:
  • Phone: 626-999-1163
  • Fax:
Mailing address:
  • Phone: 626-999-1163
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC19132
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: