Provider Demographics
NPI:1538201223
Name:MANN, LAURIE ELLEN (OMD LAC MH)
Entity type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:ELLEN
Last Name:MANN
Suffix:
Gender:F
Credentials:OMD LAC MH
Other - Prefix:DR
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:MANN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OMD LAC MH
Mailing Address - Street 1:30423 CANWOOD STREET
Mailing Address - Street 2:SUITE 137
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301
Mailing Address - Country:US
Mailing Address - Phone:818-575-9488
Mailing Address - Fax:818-575-9491
Practice Address - Street 1:30423 CANWOOD STREET
Practice Address - Street 2:SUITE 137
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301
Practice Address - Country:US
Practice Address - Phone:818-575-9488
Practice Address - Fax:818-575-9491
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC2769171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist