Provider Demographics
NPI:1164578431
Name:LO, MARIE-LOUISE (LAC)
Entity Type:Individual
Prefix:MISS
First Name:MARIE-LOUISE
Middle Name:
Last Name:LO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:MISS
Other - First Name:LOUISE
Other - Middle Name:
Other - Last Name:LO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC
Mailing Address - Street 1:17923 TANGERINE WAY
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-7079
Mailing Address - Country:US
Mailing Address - Phone:909-305-3888
Mailing Address - Fax:
Practice Address - Street 1:6841 MAGNOLIA AVE STE A
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-2864
Practice Address - Country:US
Practice Address - Phone:951-801-4217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2013-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC10865171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist