Provider Demographics
NPI:1184801904
Name:FRANCO, MARK ANTHONY (LAC)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:ANTHONY
Last Name:FRANCO
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:8780 VAN NUYS BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:PANORAMA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91402-2412
Mailing Address - Country:US
Mailing Address - Phone:818-894-4785
Mailing Address - Fax:818-894-6061
Practice Address - Street 1:8780 VAN NUYS BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-2412
Practice Address - Country:US
Practice Address - Phone:818-894-4785
Practice Address - Fax:818-894-6061
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-23
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC71970171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC0071970Medicaid