Provider Demographics
NPI:1720419989
Name:WEST COAST ACUPUNCTURE & ORIENTAL MEDICINE, LLC
Entity Type:Organization
Organization Name:WEST COAST ACUPUNCTURE & ORIENTAL MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LUCIENNE
Authorized Official - Middle Name:S
Authorized Official - Last Name:LALLEMAND
Authorized Official - Suffix:
Authorized Official - Credentials:AP
Authorized Official - Phone:239-348-0742
Mailing Address - Street 1:5475 GOLDEN GATE PKWY
Mailing Address - Street 2:UNIT 4
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34116-7529
Mailing Address - Country:US
Mailing Address - Phone:239-348-0742
Mailing Address - Fax:941-564-2295
Practice Address - Street 1:5475 GOLDEN GATE PKWY
Practice Address - Street 2:UNIT 4
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34116-7529
Practice Address - Country:US
Practice Address - Phone:239-348-0742
Practice Address - Fax:941-564-2295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-12
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP 3294171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty