Provider Demographics
NPI:1063962876
Name:SOUTHERN CALIFORNIA ACUPUNCTURE INC
Entity type:Organization
Organization Name:SOUTHERN CALIFORNIA ACUPUNCTURE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURENE
Authorized Official - Middle Name:L
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:949-892-9167
Mailing Address - Street 1:30131 TOWN CENTER DR STE 164
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-2086
Mailing Address - Country:US
Mailing Address - Phone:949-545-7650
Mailing Address - Fax:949-607-3091
Practice Address - Street 1:30131 TOWN CENTER DR STE 164
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-2086
Practice Address - Country:US
Practice Address - Phone:949-892-9167
Practice Address - Fax:949-607-3091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-05
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14214171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty