Provider Demographics
NPI:1821153263
Name:SNELSON, CONNIE L (LAC,,CA, NCCA,)
Entity Type:Individual
Prefix:MS
First Name:CONNIE
Middle Name:L
Last Name:SNELSON
Suffix:
Gender:F
Credentials:LAC,,CA, NCCA,
Other - Prefix:MS
Other - First Name:CONSTANCE
Other - Middle Name:L
Other - Last Name:SNELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LIC ACUPUNCTURIST
Mailing Address - Street 1:233 AVENIDA DEL NORTE
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-5729
Mailing Address - Country:US
Mailing Address - Phone:310-316-1441
Mailing Address - Fax:310-792-1470
Practice Address - Street 1:233 AVENIDA DEL NORTE
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-5729
Practice Address - Country:US
Practice Address - Phone:310-316-1441
Practice Address - Fax:310-792-1470
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC3930171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist