Provider Demographics
NPI:1578628178
Name:PURCELL, SATHYA S (LAC, OTR)
Entity Type:Individual
Prefix:MR
First Name:SATHYA
Middle Name:S
Last Name:PURCELL
Suffix:
Gender:M
Credentials:LAC, OTR
Other - Prefix:MR
Other - First Name:SATCH
Other - Middle Name:S
Other - Last Name:PURCELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC, OTR
Mailing Address - Street 1:13224 NEWPORT AVE
Mailing Address - Street 2:#11-C
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3401
Mailing Address - Country:US
Mailing Address - Phone:714-368-1432
Mailing Address - Fax:
Practice Address - Street 1:18121 IRVINE BLVD
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3408
Practice Address - Country:US
Practice Address - Phone:714-482-7111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-25
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6272171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist