Provider Demographics
NPI:1497927669
Name:CORSO, JEANNE (LAC)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:
Last Name:CORSO
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 1:709 W PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-3803
Mailing Address - Country:US
Mailing Address - Phone:619-293-0185
Mailing Address - Fax:858-454-9771
Practice Address - Street 1:3737 MORAGA AVE. STE A305
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117
Practice Address - Country:US
Practice Address - Phone:858-454-9771
Practice Address - Fax:858-454-9785
Is Sole Proprietor?:No
Enumeration Date:2008-03-28
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC2972171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist