Provider Demographics
NPI:1609940345
Name:KIRKLAND, SABRINA SHAYNE (LAC)
Entity Type:Individual
Prefix:
First Name:SABRINA
Middle Name:SHAYNE
Last Name:KIRKLAND
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:PO BOX 1864
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91376-1864
Mailing Address - Country:US
Mailing Address - Phone:818-378-0892
Mailing Address - Fax:818-334-4131
Practice Address - Street 1:2743 GREAT SMOKEY CT
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91362-3727
Practice Address - Country:US
Practice Address - Phone:818-378-0892
Practice Address - Fax:818-334-4130
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 11314171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist