Provider Demographics
NPI:1669549143
Name:LAHOZ, COLET STELLA (RN LAC)
Entity type:Individual
Prefix:MS
First Name:COLET
Middle Name:STELLA
Last Name:LAHOZ
Suffix:
Gender:F
Credentials:RN LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5770 W BALD EAGLE BLVD
Mailing Address - Street 2:
Mailing Address - City:WHITE BEAR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55110-6440
Mailing Address - Country:US
Mailing Address - Phone:651-429-9595
Mailing Address - Fax:651-429-9595
Practice Address - Street 1:5770 W BALD EAGLE BLVD
Practice Address - Street 2:
Practice Address - City:WHITE BEAR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55110-6440
Practice Address - Country:US
Practice Address - Phone:651-429-9595
Practice Address - Fax:651-429-9595
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1013171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN70S02LAOtherBCBS ID NUMBER
MNHP35766OtherHP ID NUMBER