Provider Demographics
NPI:1376975292
Name:AMY K. LESAGE, L.AC.
Entity Type:Organization
Organization Name:AMY K. LESAGE, L.AC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:LESAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-505-3346
Mailing Address - Street 1:6615 E PACIFIC COAST HWY
Mailing Address - Street 2:SUITE 105
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90803-4211
Mailing Address - Country:US
Mailing Address - Phone:562-594-6680
Mailing Address - Fax:
Practice Address - Street 1:6615 E PACIFIC COAST HWY
Practice Address - Street 2:SUITE 105
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90803-4211
Practice Address - Country:US
Practice Address - Phone:562-594-6680
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-01
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 11261171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty