Provider Demographics
NPI:1972792646
Name:LELIE, JUDY (MS, LAC)
Entity type:Individual
Prefix:
First Name:JUDY
Middle Name:
Last Name:LELIE
Suffix:
Gender:F
Credentials:MS, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:531 ENCINITAS BLVD
Mailing Address - Street 2:STE 100
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-3741
Mailing Address - Country:US
Mailing Address - Phone:760-753-2157
Mailing Address - Fax:
Practice Address - Street 1:531 ENCINITAS BLVD
Practice Address - Street 2:STE 100
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-3741
Practice Address - Country:US
Practice Address - Phone:760-753-2157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-18
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC11326171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist