Provider Demographics
NPI:1306420591
Name:HOLMES, STEPHANIE (LAC)
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:
Last Name:HOLMES
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 1:575 S BARRINGTON AVE APT 204
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-4339
Mailing Address - Country:US
Mailing Address - Phone:619-992-0973
Mailing Address - Fax:
Practice Address - Street 1:8500 MELROSE AVE STE 210
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90069-5169
Practice Address - Country:US
Practice Address - Phone:310-927-3097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-12
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19106171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist