Provider Demographics
NPI:1306294657
Name:LAVECK, LONDA (LAC)
Entity type:Individual
Prefix:
First Name:LONDA
Middle Name:
Last Name:LAVECK
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 S MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-3116
Mailing Address - Country:US
Mailing Address - Phone:562-760-2338
Mailing Address - Fax:
Practice Address - Street 1:1224 E GREEN ST
Practice Address - Street 2:SUIRE#100
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-3171
Practice Address - Country:US
Practice Address - Phone:626-807-0267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-26
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC17034171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist