Healthcare Provider Details

I. General information

NPI: 1619673670
Provider Name (Legal Business Name): LOELLA HSU L.AC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2023
Last Update Date: 02/01/2023
Certification Date: 02/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 MILL VALLEY RD
POMONA CA
91766-4847
US

IV. Provider business mailing address

10 MILL VALLEY RD
POMONA CA
91766-4847
US

V. Phone/Fax

Practice location:
  • Phone: 310-293-0885
  • Fax:
Mailing address:
  • Phone: 310-293-0885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC19324
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: