Provider Demographics
NPI:1891197661
Name:ALBRECHT L.AC., ELOISE (LAC)
Entity Type:Individual
Prefix:
First Name:ELOISE
Middle Name:
Last Name:ALBRECHT L.AC.
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 1:12122 EAST TRL
Mailing Address - Street 2:
Mailing Address - City:SYLMAR
Mailing Address - State:CA
Mailing Address - Zip Code:91342-6204
Mailing Address - Country:US
Mailing Address - Phone:818-749-3454
Mailing Address - Fax:
Practice Address - Street 1:3460 OCEAN VIEW BLVD
Practice Address - Street 2:SUITE G
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91208-1538
Practice Address - Country:US
Practice Address - Phone:818-749-3454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-23
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15711171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist