Provider Demographics
NPI:1295155125
Name:WLASIUK, TERESA (LAC, CMT, LMT)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:WLASIUK
Suffix:
Gender:F
Credentials:LAC, CMT, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8939 S SEPULVEDA BLVD STE 430
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-3655
Mailing Address - Country:US
Mailing Address - Phone:424-248-5412
Mailing Address - Fax:
Practice Address - Street 1:8939 S SEPULVEDA BLVD STE 430
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-3655
Practice Address - Country:US
Practice Address - Phone:424-248-5412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-17
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 15878171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist