Provider Demographics
NPI:1518438886
Name:MORANTE, LIESL KRISTIN (LAC)
Entity Type:Individual
Prefix:
First Name:LIESL
Middle Name:KRISTIN
Last Name:MORANTE
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 1:231 N MYERS ST
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91506-2316
Mailing Address - Country:US
Mailing Address - Phone:818-237-8440
Mailing Address - Fax:
Practice Address - Street 1:12153 VENTURA BLVD STE 104
Practice Address - Street 2:
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-2500
Practice Address - Country:US
Practice Address - Phone:818-515-4496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist