Provider Demographics
NPI:1750520607
Name:AVERILL, JEFFERY PRESCOTT (LAC)
Entity type:Individual
Prefix:MR
First Name:JEFFERY
Middle Name:PRESCOTT
Last Name:AVERILL
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5808 E NAPLES PLZ
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90803-5039
Mailing Address - Country:US
Mailing Address - Phone:562-856-9294
Mailing Address - Fax:562-684-4441
Practice Address - Street 1:5808 E NAPLES PLZ
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90803-5039
Practice Address - Country:US
Practice Address - Phone:562-856-9294
Practice Address - Fax:562-684-4441
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-17
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 7343171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist