Provider Demographics
NPI:1023312139
Name:SEO, ASHLEY (LAC)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:SEO
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 1:25538 DEL MAR AVE APT 6
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94542-1852
Mailing Address - Country:US
Mailing Address - Phone:925-577-5680
Mailing Address - Fax:
Practice Address - Street 1:25538 DEL MAR AVENUE,APT 6
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94542
Practice Address - Country:US
Practice Address - Phone:925-577-5680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-04
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 13403171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist