Healthcare Provider Details

I. General information

NPI: 1821130584
Provider Name (Legal Business Name): NORMA SILVIA KEUKELAAR LAC NCCOM LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3045 HARRISON ST
RIVERSIDE CA
92503-5555
US

IV. Provider business mailing address

3045 HARRISON ST
RIVERSIDE CA
92503-5555
US

V. Phone/Fax

Practice location:
  • Phone: 951-689-1247
  • Fax:
Mailing address:
  • Phone: 951-689-1247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC5027
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number002018
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: