Provider Demographics
NPI:1346403201
Name:PERRINO, LISA JEANNE (LAC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:JEANNE
Last Name:PERRINO
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 1:2769 AUTUMN RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91362-4934
Mailing Address - Country:US
Mailing Address - Phone:805-907-2123
Mailing Address - Fax:
Practice Address - Street 1:890 HAMPSHIRE RD
Practice Address - Street 2:SUITE S
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-2812
Practice Address - Country:US
Practice Address - Phone:805-907-2123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-09
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC9883171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist