Provider Demographics
NPI:1346420932
Name:HUDSON, JOANN CLARA (LAC)
Entity Type:Individual
Prefix:
First Name:JOANN
Middle Name:CLARA
Last Name:HUDSON
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 1:4306 W 8TH ST.
Mailing Address - Street 2:#4
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90005
Mailing Address - Country:US
Mailing Address - Phone:310-621-9491
Mailing Address - Fax:323-424-3883
Practice Address - Street 1:4306 W 8TH ST.
Practice Address - Street 2:#4
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90005
Practice Address - Country:US
Practice Address - Phone:310-621-9491
Practice Address - Fax:323-424-3883
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-12
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC7342171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist