Provider Demographics
NPI:1417268822
Name:DORSEY, ELIZABETH (BETH DORSEY, LAC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:DORSEY
Suffix:
Gender:F
Credentials:BETH DORSEY, LAC
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:
Other - Last Name:DORSEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BETH DORSEY LAC
Mailing Address - Street 1:4841 SOQUEL DR
Mailing Address - Street 2:
Mailing Address - City:SOQUEL
Mailing Address - State:CA
Mailing Address - Zip Code:95073-2428
Mailing Address - Country:US
Mailing Address - Phone:831-475-1055
Mailing Address - Fax:831-476-2305
Practice Address - Street 1:4841 SOQUEL DR
Practice Address - Street 2:
Practice Address - City:SOQUEL
Practice Address - State:CA
Practice Address - Zip Code:95073-2428
Practice Address - Country:US
Practice Address - Phone:831-475-1055
Practice Address - Fax:841-476-2305
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-30
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC11479171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist