Healthcare Provider Details

I. General information

NPI: 1053771121
Provider Name (Legal Business Name): LO ACUPUNCTURE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2016
Last Update Date: 03/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6841 MAGNOLIA AVE STE A
RIVERSIDE CA
92506-2864
US

IV. Provider business mailing address

6841 MAGNOLIA AVE STE A
RIVERSIDE CA
92506-2864
US

V. Phone/Fax

Practice location:
  • Phone: 951-801-4217
  • Fax:
Mailing address:
  • Phone: 951-801-4217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC10001
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC10865
License Number StateCA

VIII. Authorized Official

Name: DR. MARIE-LOUISE LO
Title or Position: CEO
Credential: L.AC
Phone: 951-801-4217