Provider Demographics
NPI:1699821249
Name:PAOLETTI, LORENA (LAC)
Entity Type:Individual
Prefix:MRS
First Name:LORENA
Middle Name:
Last Name:PAOLETTI
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 11177
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90295-7177
Mailing Address - Country:US
Mailing Address - Phone:213-220-7932
Mailing Address - Fax:213-220-7932
Practice Address - Street 1:4477 W 118TH ST
Practice Address - Street 2:SUITE 105
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-2255
Practice Address - Country:US
Practice Address - Phone:213-220-7932
Practice Address - Fax:213-220-7932
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC9281171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC9281OtherLICENSE