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General NPI Number Information
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NPI Number | 1821274465
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Entity Type | Individual
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Provider Name | KAISA MARIE LOPES L.AC.
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Gender | Female
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Dates
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Enumeration Date | 01/14/2008
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Last Update Date | 01/14/2008
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Provider Practice Location Address
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Address Line | 22691 LAMBERT ST SUITE 512
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City | LAKE FOREST
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State | CA
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Zip | 92630-1614
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Country | US
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Telephone | 949-533-7114
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Fax |
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Provider Business Mailing Address
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Address Line | 21082 CIMMARON LN
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City | TRABUCO CANYON
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State | CA
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Zip | 92679-3300
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Country | US
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Telephone | 949-533-7114
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Fax | 949-713-3882
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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 12077
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License Number State | CA
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