Provider Demographics
NPI:1679610232
Name:LAM, MARIBEL SUSANA (LAC)
Entity Type:Individual
Prefix:DR
First Name:MARIBEL
Middle Name:SUSANA
Last Name:LAM
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:PO BOX 1580
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-0580
Mailing Address - Country:US
Mailing Address - Phone:310-339-2712
Mailing Address - Fax:
Practice Address - Street 1:403 N PACIFIC COAST HWY
Practice Address - Street 2:201
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-2839
Practice Address - Country:US
Practice Address - Phone:310-798-8777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC8147171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist