Provider Demographics
NPI:1558660506
Name:NELSON, LISA C (ACUPUPUNCTURIST)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:C
Last Name:NELSON
Suffix:
Gender:F
Credentials:ACUPUPUNCTURIST
Other - Prefix:DR
Other - First Name:LISA
Other - Middle Name:C
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ACUPUNCTURIST
Mailing Address - Street 1:13315 W WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-5169
Mailing Address - Country:US
Mailing Address - Phone:310-577-3000
Mailing Address - Fax:
Practice Address - Street 1:13315 W WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-5169
Practice Address - Country:US
Practice Address - Phone:310-577-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-16
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11776171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist