Provider Demographics
NPI:1215577747
Name:BOOTH, ALISON (LAC, DIPL AC)
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:
Last Name:BOOTH
Suffix:
Gender:F
Credentials:LAC, DIPL AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1824 W 146TH ST APT B
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90249-3378
Mailing Address - Country:US
Mailing Address - Phone:310-532-3373
Mailing Address - Fax:
Practice Address - Street 1:28122 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90732
Practice Address - Country:US
Practice Address - Phone:310-935-2470
Practice Address - Fax:424-536-3013
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-13
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC15705171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist