Provider Demographics
NPI:1639353543
Name:BUCZEK, LYNN ANNE (LAC)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:ANNE
Last Name:BUCZEK
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 1:2615 CAMINO DEL RIO S
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3713
Mailing Address - Country:US
Mailing Address - Phone:619-542-0884
Mailing Address - Fax:619-542-0949
Practice Address - Street 1:2615 CAMINO DEL RIO S
Practice Address - Street 2:SUITE 201
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3713
Practice Address - Country:US
Practice Address - Phone:619-542-0884
Practice Address - Fax:619-542-0949
Is Sole Proprietor?:No
Enumeration Date:2007-12-27
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC11906171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist