Provider Demographics
NPI:1467627117
Name:SCHWARTZ, LISA BONNIE (LAC)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:BONNIE
Last Name:SCHWARTZ
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 1:3544 S CENTINELA AVE APT 106
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-2764
Mailing Address - Country:US
Mailing Address - Phone:310-804-8573
Mailing Address - Fax:
Practice Address - Street 1:3544 S CENTINELA AVE APT 106
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-2764
Practice Address - Country:US
Practice Address - Phone:310-804-8573
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA7349171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist