Provider Demographics
NPI:1235850785
Name:RICHARDSON, JANEL (LAC, MSTOM)
Entity Type:Individual
Prefix:MS
First Name:JANEL
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:LAC, MSTOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5030 LAKIBA PALMER AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92102-3746
Mailing Address - Country:US
Mailing Address - Phone:619-943-0162
Mailing Address - Fax:
Practice Address - Street 1:5030 LAKIBA PALMER AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92102-3746
Practice Address - Country:US
Practice Address - Phone:619-943-0162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-02
Last Update Date:2022-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18641171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist