Provider Demographics
NPI:1821130584
Name:KEUKELAAR, NORMA SILVIA (LAC NCCOM LAC)
Entity Type:Individual
Prefix:MS
First Name:NORMA
Middle Name:SILVIA
Last Name:KEUKELAAR
Suffix:
Gender:F
Credentials:LAC NCCOM LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3045 HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-5555
Mailing Address - Country:US
Mailing Address - Phone:951-689-1247
Mailing Address - Fax:
Practice Address - Street 1:3045 HARRISON ST
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-5555
Practice Address - Country:US
Practice Address - Phone:951-689-1247
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC5027171100000X
002018171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist