Provider Demographics
NPI:1417302373
Name:WHAN, RAMONA (LAC)
Entity Type:Individual
Prefix:
First Name:RAMONA
Middle Name:
Last Name:WHAN
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 1:33357 CHERT LN
Mailing Address - Street 2:
Mailing Address - City:WILDOMAR
Mailing Address - State:CA
Mailing Address - Zip Code:92595-6928
Mailing Address - Country:US
Mailing Address - Phone:714-588-4291
Mailing Address - Fax:
Practice Address - Street 1:33357 CHERT LN
Practice Address - Street 2:
Practice Address - City:WILDOMAR
Practice Address - State:CA
Practice Address - Zip Code:92595-6928
Practice Address - Country:US
Practice Address - Phone:714-588-4291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-28
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16979171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist