=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821345307
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NAUSICAA C.A. BOSNEANU-DE SOUZA LAC.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/14/2012
-----------------------------------------------------
Last Update Date | 08/14/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 24445 HAWTHORNE BLVD SUITE 104
-----------------------------------------------------
City | TORRANCE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90505-6562
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 213-422-3422
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1401 E 3RD ST #15
-----------------------------------------------------
City | LONG BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90802-3615
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 213-422-3422
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | AC 14285
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------