Provider Demographics
NPI:1073729000
Name:LACORE, CERISE MICHELLE (BSC, CMT)
Entity Type:Individual
Prefix:
First Name:CERISE
Middle Name:MICHELLE
Last Name:LACORE
Suffix:
Gender:F
Credentials:BSC, CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 N SUNRISE AVE STE 1016
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-2930
Mailing Address - Country:US
Mailing Address - Phone:916-956-2181
Mailing Address - Fax:
Practice Address - Street 1:151 N SUNRISE AVE STE 1016
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-2930
Practice Address - Country:US
Practice Address - Phone:916-956-2181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist