Provider Demographics
NPI:1679770309
Name:SBROCCO, LINA MARIA (ND, LAC)
Entity Type:Individual
Prefix:
First Name:LINA
Middle Name:MARIA
Last Name:SBROCCO
Suffix:
Gender:F
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25001 EMERY RD, BLDG 25E
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WARRENSVILLE HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44128
Mailing Address - Country:US
Mailing Address - Phone:216-285-4070
Mailing Address - Fax:
Practice Address - Street 1:25001 EMERY RD, BLDG 25E
Practice Address - Street 2:SUITE 100
Practice Address - City:WARRENSVILLE HTS
Practice Address - State:OH
Practice Address - Zip Code:44128
Practice Address - Country:US
Practice Address - Phone:216-285-4070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT00001103175F00000X
OH65.000069171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No175F00000XOther Service ProvidersNaturopath