Provider Demographics
NPI:1699846956
Name:LACKPOUR, SEPIDEH (LAC PHD)
Entity Type:Individual
Prefix:DR
First Name:SEPIDEH
Middle Name:
Last Name:LACKPOUR
Suffix:
Gender:F
Credentials:LAC PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:827 DEEP VALLEY DR
Mailing Address - Street 2:SUITE #103
Mailing Address - City:ROLLING HILLS ESTATES
Mailing Address - State:CA
Mailing Address - Zip Code:90274-3647
Mailing Address - Country:US
Mailing Address - Phone:310-265-9588
Mailing Address - Fax:310-265-9584
Practice Address - Street 1:827 DEEP VALLEY DR
Practice Address - Street 2:SUITE #103
Practice Address - City:ROLLING HILLS ESTATES
Practice Address - State:CA
Practice Address - Zip Code:90274-3647
Practice Address - Country:US
Practice Address - Phone:310-265-9588
Practice Address - Fax:310-265-9584
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC5194171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist