Provider Demographics
NPI:1952332686
Name:WOODHOUSE, LOUELLA (LAC)
Entity Type:Individual
Prefix:
First Name:LOUELLA
Middle Name:
Last Name:WOODHOUSE
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 1:3320 3RD AVE STE B
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-5684
Mailing Address - Country:US
Mailing Address - Phone:619-293-3094
Mailing Address - Fax:619-293-3053
Practice Address - Street 1:3320 3RD AVE STE B
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-5684
Practice Address - Country:US
Practice Address - Phone:619-293-3094
Practice Address - Fax:619-293-3053
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC7670171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist