Provider Demographics
NPI:1164735833
Name:BEALER, LAURA (LAC)
Entity Type:Individual
Prefix:MISS
First Name:LAURA
Middle Name:
Last Name:BEALER
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 1:890 HAMPSHIRE RD
Mailing Address - Street 2:SUITE S
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-2812
Mailing Address - Country:US
Mailing Address - Phone:805-379-1108
Mailing Address - Fax:805-379-2779
Practice Address - Street 1:890 HAMPSHIRE RD
Practice Address - Street 2:SUITE S
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-2812
Practice Address - Country:US
Practice Address - Phone:805-379-1108
Practice Address - Fax:805-379-2779
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-22
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC13450171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist