Provider Demographics
NPI:1609070721
Name:LISLE, DARREN GLEN (LAC,)
Entity Type:Individual
Prefix:
First Name:DARREN
Middle Name:GLEN
Last Name:LISLE
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 1:960 GLEN ANNIE RD
Mailing Address - Street 2:
Mailing Address - City:GOLETA
Mailing Address - State:CA
Mailing Address - Zip Code:93117-1413
Mailing Address - Country:US
Mailing Address - Phone:805-968-2665
Mailing Address - Fax:
Practice Address - Street 1:9 E MISSION ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-2414
Practice Address - Country:US
Practice Address - Phone:805-563-8660
Practice Address - Fax:805-563-8662
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC7105171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist