Healthcare Provider Details

I. General information

NPI: 1942967583
Provider Name (Legal Business Name): LISA ANN YEE LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISA ANN CROSETTI

II. Dates (important events)

Enumeration Date: 11/18/2021
Last Update Date: 11/18/2021
Certification Date: 11/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 MAIN ST # C
WOODLAND CA
95695-3560
US

IV. Provider business mailing address

PO BOX 244
GRASS VALLEY CA
95945-0244
US

V. Phone/Fax

Practice location:
  • Phone: 530-666-5038
  • Fax:
Mailing address:
  • Phone: 925-548-5327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number19230
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: