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General NPI Number Information
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NPI Number | 1063962876
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Entity Type | Organization
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Legal Business Name | SOUTHERN CALIFORNIA ACUPUNCTURE INC
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Dates
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Enumeration Date | 10/05/2016
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Last Update Date | 11/19/2018
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Provider Practice Location Address
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Address Line | 30131 TOWN CENTER DR STE 164
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City | LAGUNA NIGUEL
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State | CA
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Zip | 92677-2086
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Country | US
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Telephone | 949-892-9167
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Fax | 949-607-3091
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Provider Business Mailing Address
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Address Line | 30131 TOWN CENTER DR STE 164
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City | LAGUNA NIGUEL
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State | CA
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Zip | 92677-2086
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Country | US
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Telephone | 949-545-7650
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Fax | 949-607-3091
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Authorized Official
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Title or Position | OWNER
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Name | LAURENE L MARSHALL
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Credential | L.AC.
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Telephone | 949-892-9167
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 14214
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License Number State | CA
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