Provider Demographics
NPI:1629129713
Name:FADDEN, JAN SCOTT (LAC)
Entity Type:Individual
Prefix:MISS
First Name:JAN
Middle Name:SCOTT
Last Name:FADDEN
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 1:965 MIRAMONTE DR APT 2
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93109-1330
Mailing Address - Country:US
Mailing Address - Phone:805-564-8384
Mailing Address - Fax:
Practice Address - Street 1:4046 FOOTHILL RD
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93110-1254
Practice Address - Country:US
Practice Address - Phone:805-682-2153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3797171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist