Provider Demographics
NPI:1356433916
Name:REID-BRETELL, ALISON SHANNON (LAC)
Entity type:Individual
Prefix:MS
First Name:ALISON
Middle Name:SHANNON
Last Name:REID-BRETELL
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
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Mailing Address - Street 1:681 ENCINITAS BLVD STE 316
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-3762
Mailing Address - Country:US
Mailing Address - Phone:760-632-6979
Mailing Address - Fax:760-632-6980
Practice Address - Street 1:681 ENCINITAS BLVD STE 316
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-3762
Practice Address - Country:US
Practice Address - Phone:760-632-6979
Practice Address - Fax:760-632-6980
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC5400171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist