Provider Demographics
NPI:1497530760
Name:CIVELLO, LAUREN SARA (LAC)
Entity Type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:SARA
Last Name:CIVELLO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:17525 VENTURA BLVD STE 108
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-5106
Mailing Address - Country:US
Mailing Address - Phone:818-817-0049
Mailing Address - Fax:818-817-0958
Practice Address - Street 1:17525 VENTURA BLVD STE 108
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-5106
Practice Address - Country:US
Practice Address - Phone:818-817-0049
Practice Address - Fax:818-817-0958
Is Sole Proprietor?:No
Enumeration Date:2023-08-25
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10500171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist