Provider Demographics
NPI:1740487644
Name:WIESNER, DENISE SHERI (L AC)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:SHERI
Last Name:WIESNER
Suffix:
Gender:F
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 S BARRINGTON AVE STE 220
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-5385
Mailing Address - Country:US
Mailing Address - Phone:310-473-7474
Mailing Address - Fax:310-473-9767
Practice Address - Street 1:2001 S BARRINGTON AVE STE 220
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-5385
Practice Address - Country:US
Practice Address - Phone:310-473-7474
Practice Address - Fax:310-473-9767
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 4831171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC4831OtherLICENSED ACUPUNCTURIST