Provider Demographics
NPI:1215218938
Name:SIBBERS, LORI (LAC)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:SIBBERS
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 1:24040 CAMINO DEL AVION
Mailing Address - Street 2:SUITE A 341
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-4005
Mailing Address - Country:US
Mailing Address - Phone:949-766-9228
Mailing Address - Fax:
Practice Address - Street 1:30220 RANCHO VIEJO RD
Practice Address - Street 2:SUITE F
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-1568
Practice Address - Country:US
Practice Address - Phone:949-766-9228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-08
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13636171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist