Provider Demographics
NPI:1932506763
Name:LAURINO, ANGELA (LAC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:LAURINO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:LAURINO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CMT
Mailing Address - Street 1:201 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:CA
Mailing Address - Zip Code:90291-2601
Mailing Address - Country:US
Mailing Address - Phone:646-522-1559
Mailing Address - Fax:
Practice Address - Street 1:122 LINCOLN BLVD STE 205
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:CA
Practice Address - Zip Code:90291-2859
Practice Address - Country:US
Practice Address - Phone:646-522-1559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-21
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16241171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist