Provider Demographics
NPI:1588836480
Name:FRASER, SANDRA LYNN (LAC)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:LYNN
Last Name:FRASER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:MS
Other - First Name:SANDRA
Other - Middle Name:LYNN
Other - Last Name:RUDIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:1155 CAMINO DEL MAR # 468
Mailing Address - Street 2:
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-2605
Mailing Address - Country:US
Mailing Address - Phone:858-204-9642
Mailing Address - Fax:
Practice Address - Street 1:1219 CAMINO DEL MAR
Practice Address - Street 2:
Practice Address - City:DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92014-2505
Practice Address - Country:US
Practice Address - Phone:858-793-1104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-31
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12321171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist