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General NPI Number Information
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NPI Number | 1184791113
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Entity Type | Individual
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Provider Name | AMY K. LESAGE DACM, L.AC.
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Gender | Female
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Dates
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Enumeration Date | 11/28/2006
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Last Update Date | 09/26/2024
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Provider Practice Location Address
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Address Line | 1122 BRISTOL ST STE 200
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City | COSTA MESA
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State | CA
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Zip | 92626-7972
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Country | US
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Telephone | 949-631-5226
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Fax |
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Provider Business Mailing Address
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Address Line | 10391 HESTER AVE
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City | BUENA PARK
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State | CA
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Zip | 90620-4432
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Country | US
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Telephone | 562-505-3346
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | AC 11261
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License Number State | CA
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