Provider Demographics
NPI:1790090066
Name:ZEPPEGNO, LISA MARIE (LAC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:ZEPPEGNO
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 1:3535 GRAND AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-2042
Mailing Address - Country:US
Mailing Address - Phone:510-410-7000
Mailing Address - Fax:
Practice Address - Street 1:3535 GRAND AVE STE 1
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-2042
Practice Address - Country:US
Practice Address - Phone:510-410-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-11
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7608171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist