Provider Demographics
NPI:1760572069
Name:CIMPERMAN, CARRIE LYNN (LAC)
Entity Type:Individual
Prefix:MISS
First Name:CARRIE
Middle Name:LYNN
Last Name:CIMPERMAN
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 1:26352 ARBORETUM WAY
Mailing Address - Street 2:UNIT 3505
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-7281
Mailing Address - Country:US
Mailing Address - Phone:619-985-2058
Mailing Address - Fax:
Practice Address - Street 1:27420 JEFFERSON AVE
Practice Address - Street 2:104A
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-2667
Practice Address - Country:US
Practice Address - Phone:619-985-2058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10002171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA10002OtherSTATE LICENSE NUMBER