Provider Demographics
NPI:1972863710
Name:LAKS, LAUREN PAIGE (LAC)
Entity Type:Individual
Prefix:MISS
First Name:LAUREN
Middle Name:PAIGE
Last Name:LAKS
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:PO BOX 2373
Mailing Address - Street 2:
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-2373
Mailing Address - Country:US
Mailing Address - Phone:530-303-7031
Mailing Address - Fax:
Practice Address - Street 1:1108 CORKER ST
Practice Address - Street 2:
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-6512
Practice Address - Country:US
Practice Address - Phone:530-303-7031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-28
Last Update Date:2014-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14597171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist