Provider Demographics
NPI:1386072445
Name:TAPPIN, CORIE (LAC)
Entity type:Individual
Prefix:
First Name:CORIE
Middle Name:
Last Name:TAPPIN
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 1:7230 BIRDVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:MALIBU
Mailing Address - State:CA
Mailing Address - Zip Code:90265-4111
Mailing Address - Country:US
Mailing Address - Phone:310-709-2536
Mailing Address - Fax:
Practice Address - Street 1:23440 CIVIC CENTER WAY
Practice Address - Street 2:SUITE 101
Practice Address - City:MALIBU
Practice Address - State:CA
Practice Address - Zip Code:90265-4854
Practice Address - Country:US
Practice Address - Phone:310-709-2536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-28
Last Update Date:2013-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15580171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist