Healthcare Provider Details

I. General information

NPI: 1679753107
Provider Name (Legal Business Name): PAZIONG ESTELLE LO-VANG L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2007
Last Update Date: 10/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

393 DUNLAP ST N STE 302
SAINT PAUL MN
55104-4207
US

IV. Provider business mailing address

393 DUNLAP ST N STE 302
SAINT PAUL MN
55104-4207
US

V. Phone/Fax

Practice location:
  • Phone: 651-214-5657
  • Fax: 651-493-4682
Mailing address:
  • Phone: 651-214-5657
  • Fax: 651-493-4682

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number1403
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: