Provider Demographics
NPI:1518147743
Name:MILLER, LAWRENCE RICHARD (LAC, DIPLAC&CH)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:RICHARD
Last Name:MILLER
Suffix:
Gender:M
Credentials:LAC, DIPLAC&CH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:647 SANTA CLARA AVE
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:CA
Mailing Address - Zip Code:90291-3445
Mailing Address - Country:US
Mailing Address - Phone:310-346-9177
Mailing Address - Fax:310-203-3003
Practice Address - Street 1:12114 VENICE BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-3812
Practice Address - Country:US
Practice Address - Phone:310-346-9177
Practice Address - Fax:310-203-3003
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-05
Last Update Date:2009-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC7597171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist