Provider Demographics
NPI:1497875918
Name:RISPOLI, TERESA L (LAC)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:L
Last Name:RISPOLI
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 1:28247 AGOURA RD
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-2403
Mailing Address - Country:US
Mailing Address - Phone:818-707-3126
Mailing Address - Fax:818-707-2787
Practice Address - Street 1:28247 AGOURA RD
Practice Address - Street 2:
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-2403
Practice Address - Country:US
Practice Address - Phone:818-707-3126
Practice Address - Fax:818-707-2787
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC5728171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist