Provider Demographics
NPI:1376873604
Name:INOUE, LEA ANNE (LEA INOUE)
Entity Type:Individual
Prefix:
First Name:LEA
Middle Name:ANNE
Last Name:INOUE
Suffix:
Gender:F
Credentials:LEA INOUE
Other - Prefix:
Other - First Name:LEA
Other - Middle Name:ANNE
Other - Last Name:INOUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC, DIPL CH
Mailing Address - Street 1:953 W ENID CIR
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-3459
Mailing Address - Country:US
Mailing Address - Phone:480-612-5007
Mailing Address - Fax:
Practice Address - Street 1:953 W ENID CIRCLE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210
Practice Address - Country:US
Practice Address - Phone:480-612-5007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-08
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0363171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist