Provider Demographics
NPI:1548591993
Name:EDGCOMB, LAURIE EVE (LAC)
Entity Type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:EVE
Last Name:EDGCOMB
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:PO BOX 1162
Mailing Address - Street 2:
Mailing Address - City:OJAI
Mailing Address - State:CA
Mailing Address - Zip Code:93024-1162
Mailing Address - Country:US
Mailing Address - Phone:805-646-1360
Mailing Address - Fax:
Practice Address - Street 1:102 E ALISO ST
Practice Address - Street 2:
Practice Address - City:OJAI
Practice Address - State:CA
Practice Address - Zip Code:93023-2602
Practice Address - Country:US
Practice Address - Phone:805-646-1360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-25
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC2708171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist