Provider Demographics
NPI:1679037196
Name:SWICEGOOD, KRISTI ELIZABETH (LAC)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:ELIZABETH
Last Name:SWICEGOOD
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 1:3252 BENNETT DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90068-1702
Mailing Address - Country:US
Mailing Address - Phone:323-333-9844
Mailing Address - Fax:
Practice Address - Street 1:9740 WILSHIRE BLVD STE B
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-1820
Practice Address - Country:US
Practice Address - Phone:323-333-9844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-29
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10183171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist