Provider Demographics
NPI:1619146958
Name:ALBRECHT, TRACY K (LAC, MTOM)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:K
Last Name:ALBRECHT
Suffix:
Gender:F
Credentials:LAC, MTOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2940 WESTWOOD BLVD
Mailing Address - Street 2:SUITE #5
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-4145
Mailing Address - Country:US
Mailing Address - Phone:310-779-0633
Mailing Address - Fax:
Practice Address - Street 1:2940 WESTWOOD BLVD
Practice Address - Street 2:SUITE #5
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-4145
Practice Address - Country:US
Practice Address - Phone:310-779-0633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-20
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 11648171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist