Provider Demographics
NPI:1598137101
Name:BRIDGES, ALEC (LAC)
Entity Type:Individual
Prefix:
First Name:ALEC
Middle Name:
Last Name:BRIDGES
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 COPELAND CT APT C
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-4478
Mailing Address - Country:US
Mailing Address - Phone:323-717-5433
Mailing Address - Fax:
Practice Address - Street 1:655 COPELAND CT APT C
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-4478
Practice Address - Country:US
Practice Address - Phone:323-717-5433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-22
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16792171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist