Provider Demographics
NPI:1285830869
Name:HYSELL, TEVY ARUNSON (LAC)
Entity Type:Individual
Prefix:MRS
First Name:TEVY
Middle Name:ARUNSON
Last Name:HYSELL
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:693 GLORIA AVE
Mailing Address - Street 2:
Mailing Address - City:SANGER
Mailing Address - State:CA
Mailing Address - Zip Code:93657-3564
Mailing Address - Country:US
Mailing Address - Phone:559-708-6810
Mailing Address - Fax:559-875-2337
Practice Address - Street 1:2514 JENSEN AVE STE 103
Practice Address - Street 2:
Practice Address - City:SANGER
Practice Address - State:CA
Practice Address - Zip Code:93657-2250
Practice Address - Country:US
Practice Address - Phone:559-875-1970
Practice Address - Fax:559-875-2337
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC10582171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist