Healthcare Provider Details

I. General information

NPI: 1578125621
Provider Name (Legal Business Name): RONGPIN FU LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2019
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18800 AMAR RD STE A8
WALNUT CA
91789-7100
US

IV. Provider business mailing address

17028 DOUBLEGROVE ST
LA PUENTE CA
91744-1508
US

V. Phone/Fax

Practice location:
  • Phone: 626-877-4468
  • Fax:
Mailing address:
  • Phone: 626-322-4553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number18012
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: