Provider Demographics
NPI:1194174029
Name:HUMSTON, ASHLEY S (LAC)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:S
Last Name:HUMSTON
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:13955 TAHITI WAY
Mailing Address - Street 2:APT 155
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-6591
Mailing Address - Country:US
Mailing Address - Phone:213-804-7918
Mailing Address - Fax:
Practice Address - Street 1:900 WILSHIRE BLVD
Practice Address - Street 2:SUITE 318
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-1872
Practice Address - Country:US
Practice Address - Phone:213-804-7918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-10
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17194171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist