Provider Demographics
NPI:1609191246
Name:PUELLES, SUSANA (LAC)
Entity Type:Individual
Prefix:
First Name:SUSANA
Middle Name:
Last Name:PUELLES
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2432 EL RANCHO VIS
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92833-1546
Mailing Address - Country:US
Mailing Address - Phone:714-986-4788
Mailing Address - Fax:
Practice Address - Street 1:7028 GREENLEAF AVE STE K
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90602-4312
Practice Address - Country:US
Practice Address - Phone:562-789-1588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-06
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13128171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist