Provider Demographics
NPI:1760160667
Name:AFFUSO, LORRAINE PERKINS (LAC)
Entity Type:Individual
Prefix:
First Name:LORRAINE
Middle Name:PERKINS
Last Name:AFFUSO
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 357
Mailing Address - Street 2:
Mailing Address - City:MOUNT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37121-0357
Mailing Address - Country:US
Mailing Address - Phone:214-681-9515
Mailing Address - Fax:
Practice Address - Street 1:33971 NAUTICUS ISLE
Practice Address - Street 2:
Practice Address - City:DANA POINT
Practice Address - State:CA
Practice Address - Zip Code:92629-4238
Practice Address - Country:US
Practice Address - Phone:214-681-9515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC6071171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty