Provider Demographics
NPI:1427776426
Name:WEATHERBEE, LAURA (LAC)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:WEATHERBEE
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 1:1625 FROUDE ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92107-3512
Mailing Address - Country:US
Mailing Address - Phone:646-670-0336
Mailing Address - Fax:
Practice Address - Street 1:2204 GARNET AVE STE 202
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-3771
Practice Address - Country:US
Practice Address - Phone:619-880-0470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-16
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19165171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist