Provider Demographics
NPI:1861686552
Name:GONZALES, LAUREN ROSALIE (LAC)
Entity Type:Individual
Prefix:MISS
First Name:LAUREN
Middle Name:ROSALIE
Last Name:GONZALES
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:23133 HAWTHORNE BLVD
Mailing Address - Street 2:SUITE B-03
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-3729
Mailing Address - Country:US
Mailing Address - Phone:310-378-4223
Mailing Address - Fax:310-378-2535
Practice Address - Street 1:23133 HAWTHORNE BLVD
Practice Address - Street 2:SUITE B-03
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-3729
Practice Address - Country:US
Practice Address - Phone:310-378-4223
Practice Address - Fax:310-378-2535
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-05
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC11739171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist