Provider Demographics
NPI:1437362449
Name:ROSS, EVA LISA (LAC)
Entity Type:Individual
Prefix:MRS
First Name:EVA
Middle Name:LISA
Last Name:ROSS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:MISS
Other - First Name:EVA
Other - Middle Name:LISA
Other - Last Name:SPENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:21355 PACIFIC COAST HWY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MALIBU
Mailing Address - State:CA
Mailing Address - Zip Code:90265-5250
Mailing Address - Country:US
Mailing Address - Phone:310-317-1554
Mailing Address - Fax:310-317-1553
Practice Address - Street 1:21355 PACIFIC COAST HWY
Practice Address - Street 2:SUITE 201
Practice Address - City:MALIBU
Practice Address - State:CA
Practice Address - Zip Code:90265-5250
Practice Address - Country:US
Practice Address - Phone:310-317-1554
Practice Address - Fax:310-317-1553
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC10553171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist