Provider Demographics
NPI:1770833840
Name:JOHN CAMESA LAC A PROFESSIONAL ACUP CORP
Entity Type:Organization
Organization Name:JOHN CAMESA LAC A PROFESSIONAL ACUP CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMESA
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:949-350-2898
Mailing Address - Street 1:707 S WEBSTER AVE #117
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-7324
Mailing Address - Country:US
Mailing Address - Phone:949-350-2898
Mailing Address - Fax:
Practice Address - Street 1:17150 EUCLID ST STE 316
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-4092
Practice Address - Country:US
Practice Address - Phone:949-350-2898
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-14
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC9257171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty