Provider Demographics
NPI:1669901583
Name:CAMPBELL, SHEILA MARIE (LAC)
Entity type:Individual
Prefix:MS
First Name:SHEILA
Middle Name:MARIE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:814 W KNOLL DR
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90069-4714
Mailing Address - Country:US
Mailing Address - Phone:310-770-0034
Mailing Address - Fax:
Practice Address - Street 1:8907 WILSHIRE BLVD STE 270
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-1929
Practice Address - Country:US
Practice Address - Phone:858-220-6469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-05
Last Update Date:2017-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC17632171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty