Provider Demographics
NPI:1437445376
Name:LOEL, LISA LAUREN (ACP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:LAUREN
Last Name:LOEL
Suffix:
Gender:F
Credentials:ACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 ARLINGTON CIR
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94947-4906
Mailing Address - Country:US
Mailing Address - Phone:415-306-4162
Mailing Address - Fax:
Practice Address - Street 1:710 ARLINGTON CIR
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94947-4906
Practice Address - Country:US
Practice Address - Phone:415-306-4162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-20
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC7450171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist