Provider Demographics
NPI:1457618324
Name:LOVELL-HAMPTON, SURRENA (LAC, DIPL OM)
Entity Type:Individual
Prefix:
First Name:SURRENA
Middle Name:
Last Name:LOVELL-HAMPTON
Suffix:
Gender:F
Credentials:LAC, DIPL OM
Other - Prefix:
Other - First Name:SURRENA
Other - Middle Name:
Other - Last Name:LOVELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3548 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-4913
Mailing Address - Country:US
Mailing Address - Phone:619-867-3756
Mailing Address - Fax:
Practice Address - Street 1:2518 JAMACHA RD
Practice Address - Street 2:#304
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92019-6314
Practice Address - Country:US
Practice Address - Phone:619-670-5123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-17
Last Update Date:2012-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14730171100000X
CA29230174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No174400000XOther Service ProvidersSpecialist