Provider Demographics
NPI:1336391101
Name:SHULMAN, JENNIFER REBECCA (LAC)
Entity Type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:REBECCA
Last Name:SHULMAN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
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Mailing Address - Street 1:1300 S PACIFIC COAST HWY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-5003
Mailing Address - Country:US
Mailing Address - Phone:805-284-2544
Mailing Address - Fax:805-284-2544
Practice Address - Street 1:1300 S PACIFIC COAST HWY
Practice Address - Street 2:SUITE 201
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-5003
Practice Address - Country:US
Practice Address - Phone:805-284-2544
Practice Address - Fax:805-284-2544
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-10
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA12784171100000X
NY004256171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist