Provider Demographics
NPI:1386889970
Name:SUTTON, DIANE C (LAC)
Entity type:Individual
Prefix:MS
First Name:DIANE
Middle Name:C
Last Name:SUTTON
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:MS
Other - First Name:DIANE
Other - Middle Name:C
Other - Last Name:SUTTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DIANE SUTTON LAC
Mailing Address - Street 1:104 NORTH SCHOOL STREET
Mailing Address - Street 2:SUITE 311
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95240-9524
Mailing Address - Country:US
Mailing Address - Phone:209-712-7570
Mailing Address - Fax:
Practice Address - Street 1:104 N SCHOOL ST
Practice Address - Street 2:SUITE 311
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95240-2148
Practice Address - Country:US
Practice Address - Phone:209-712-7570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-10
Last Update Date:2008-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC12553171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist