Provider Demographics
NPI:1497214712
Name:HINRICHS, SARAH ROSE (LAC)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:ROSE
Last Name:HINRICHS
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 1:1921 HARRIMAN LN APT 3
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-4249
Mailing Address - Country:US
Mailing Address - Phone:309-912-5682
Mailing Address - Fax:
Practice Address - Street 1:2310 ARTESIA BLVD
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90278-3114
Practice Address - Country:US
Practice Address - Phone:309-912-5682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-16
Last Update Date:2019-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC18417171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist