Provider Demographics
NPI:1891342630
Name:LIXANDRU, IULIANA (LAC)
Entity Type:Individual
Prefix:
First Name:IULIANA
Middle Name:
Last Name:LIXANDRU
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 1:501 W STATE ST STE 204
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-2184
Mailing Address - Country:US
Mailing Address - Phone:331-248-0657
Mailing Address - Fax:
Practice Address - Street 1:501 W STATE ST STE 204
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-2184
Practice Address - Country:US
Practice Address - Phone:331-248-0657
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-26
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198001462171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist