Provider Demographics
NPI:1164765020
Name:MESSELBECK, LAUREN ANN (LAC)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:ANN
Last Name:MESSELBECK
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:ANN
Other - Last Name:KOELLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:2313 HALF MOON LN
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-6738
Mailing Address - Country:US
Mailing Address - Phone:949-701-2928
Mailing Address - Fax:
Practice Address - Street 1:1501 SUPERIOR AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3600
Practice Address - Country:US
Practice Address - Phone:949-836-2857
Practice Address - Fax:949-861-3270
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-28
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15149171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist