Provider Demographics
NPI:1821274465
Name:LOPES, KAISA MARIE (LAC)
Entity Type:Individual
Prefix:
First Name:KAISA
Middle Name:MARIE
Last Name:LOPES
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 1:21082 CIMMARON LN
Mailing Address - Street 2:
Mailing Address - City:TRABUCO CANYON
Mailing Address - State:CA
Mailing Address - Zip Code:92679-3300
Mailing Address - Country:US
Mailing Address - Phone:949-533-7114
Mailing Address - Fax:949-713-3882
Practice Address - Street 1:22691 LAMBERT ST
Practice Address - Street 2:SUITE 512
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-1614
Practice Address - Country:US
Practice Address - Phone:949-533-7114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-14
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 12077171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist