Provider Demographics
NPI:1013210491
Name:ANGELONE, ELISA M (LAC)
Entity Type:Individual
Prefix:MS
First Name:ELISA
Middle Name:M
Last Name:ANGELONE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4254 BEETHOVEN ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-5706
Mailing Address - Country:US
Mailing Address - Phone:415-601-9605
Mailing Address - Fax:
Practice Address - Street 1:12114 VENICE BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-3812
Practice Address - Country:US
Practice Address - Phone:415-601-9605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-07
Last Update Date:2016-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC13438171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist