Provider Demographics
NPI:1164174942
Name:BIRD, COURTNEY (LAC)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:BIRD
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 1:16927 NORFOLK CIR
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-4817
Mailing Address - Country:US
Mailing Address - Phone:949-415-9924
Mailing Address - Fax:
Practice Address - Street 1:16485 LAGUNA CANYON RD STE 105
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3833
Practice Address - Country:US
Practice Address - Phone:949-646-4325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-22
Last Update Date:2022-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19341171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist