Provider Demographics
NPI:1437448420
Name:LA, CAROLINE (LAC)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:LA
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:PO BOX 11512
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92658-5032
Mailing Address - Country:US
Mailing Address - Phone:949-394-7137
Mailing Address - Fax:
Practice Address - Street 1:400 N TUSTIN AVE STE 380
Practice Address - Street 2:
Practice Address - City:NORTH TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92705-3833
Practice Address - Country:US
Practice Address - Phone:714-730-2233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-31
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC14123171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist