Provider Demographics
NPI:1609001122
Name:PAUSEBACK, LUCY FRANCES JEANSONNE (LAC, CMT)
Entity Type:Individual
Prefix:MRS
First Name:LUCY
Middle Name:FRANCES JEANSONNE
Last Name:PAUSEBACK
Suffix:
Gender:F
Credentials:LAC, CMT
Other - Prefix:
Other - First Name:LUCY
Other - Middle Name:FRANCES
Other - Last Name:JEANSONNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:3236 32ND ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92104-4736
Mailing Address - Country:US
Mailing Address - Phone:619-550-8511
Mailing Address - Fax:
Practice Address - Street 1:3236 32ND ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92104-4736
Practice Address - Country:US
Practice Address - Phone:415-312-9348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-28
Last Update Date:2016-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31404225700000X
CA17251171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist