Provider Demographics
NPI:1659406197
Name:PERILLAN, LUCIA G (MAC, LAC)
Entity Type:Individual
Prefix:
First Name:LUCIA
Middle Name:G
Last Name:PERILLAN
Suffix:
Gender:F
Credentials:MAC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 BROWNING CT
Mailing Address - Street 2:
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-7141
Mailing Address - Country:US
Mailing Address - Phone:310-908-2238
Mailing Address - Fax:
Practice Address - Street 1:8505 FENTON ST
Practice Address - Street 2:SUITE 202
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-4497
Practice Address - Country:US
Practice Address - Phone:310-565-4924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDUO1273171100000X
DCAC500036171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist