Provider Demographics
NPI:1427661362
Name:CORSON, ANNA C (LAC)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:C
Last Name:CORSON
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 1:21712 CANON DR
Mailing Address - Street 2:
Mailing Address - City:TOPANGA
Mailing Address - State:CA
Mailing Address - Zip Code:90290-4500
Mailing Address - Country:US
Mailing Address - Phone:203-274-0059
Mailing Address - Fax:
Practice Address - Street 1:21712 CANON DR
Practice Address - Street 2:
Practice Address - City:TOPANGA
Practice Address - State:CA
Practice Address - Zip Code:90290-4500
Practice Address - Country:US
Practice Address - Phone:203-274-0059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-29
Last Update Date:2020-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18811171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist