Provider Demographics
NPI:1023299070
Name:BREBES-MENSAH, NAOMI LEE (LAC)
Entity type:Individual
Prefix:
First Name:NAOMI
Middle Name:LEE
Last Name:BREBES-MENSAH
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 1:4415 SYCAMORE RD
Mailing Address - Street 2:
Mailing Address - City:ATASCADERO
Mailing Address - State:CA
Mailing Address - Zip Code:93422-3561
Mailing Address - Country:US
Mailing Address - Phone:805-792-0229
Mailing Address - Fax:
Practice Address - Street 1:672 HIGUERA ST STE 100
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-3585
Practice Address - Country:US
Practice Address - Phone:805-792-0229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-19
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11867171100000X
CAAC 11867171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist