Provider Demographics
NPI:1992576409
Name:AZUCENA, NORMA LISETTE (LAC)
Entity type:Individual
Prefix:
First Name:NORMA
Middle Name:LISETTE
Last Name:AZUCENA
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:PO BOX 147
Mailing Address - Street 2:
Mailing Address - City:TEMPLETON
Mailing Address - State:MA
Mailing Address - Zip Code:01468-0147
Mailing Address - Country:US
Mailing Address - Phone:310-418-3409
Mailing Address - Fax:
Practice Address - Street 1:33655 GREEN VALLEY LAKE RD
Practice Address - Street 2:
Practice Address - City:GREEN VALLEY LAKE
Practice Address - State:CA
Practice Address - Zip Code:92341
Practice Address - Country:US
Practice Address - Phone:310-418-3409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC16667171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist