Provider Demographics
NPI:1356100127
Name:LONDON, SHOSHANA (DTCM, LAC)
Entity type:Individual
Prefix:DR
First Name:SHOSHANA
Middle Name:
Last Name:LONDON
Suffix:
Gender:F
Credentials:DTCM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11264 NEWTOWN RD
Mailing Address - Street 2:
Mailing Address - City:NEVADA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95959-9728
Mailing Address - Country:US
Mailing Address - Phone:530-362-8232
Mailing Address - Fax:
Practice Address - Street 1:206 PROVIDENCE MINE RD STE 115
Practice Address - Street 2:
Practice Address - City:NEVADA CITY
Practice Address - State:CA
Practice Address - Zip Code:95959-2956
Practice Address - Country:US
Practice Address - Phone:530-900-4304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-15
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20033171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist