Provider Demographics
NPI:1598055980
Name:VEACH, CANDACE D (MTOM, LAC)
Entity Type:Individual
Prefix:MS
First Name:CANDACE
Middle Name:D
Last Name:VEACH
Suffix:
Gender:F
Credentials:MTOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11611 SAN VICENTE BLVD.
Mailing Address - Street 2:SUITE 605
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049
Mailing Address - Country:US
Mailing Address - Phone:310-795-8500
Mailing Address - Fax:310-826-9152
Practice Address - Street 1:11611 SAN VICENTE BLVD
Practice Address - Street 2:SUITE 605
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-5106
Practice Address - Country:US
Practice Address - Phone:310-795-8500
Practice Address - Fax:310-826-9152
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-19
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC#8307133NN1002X, 171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education