Provider Demographics
NPI:1811345481
Name:SAXENA, LORELLE (LAC)
Entity type:Individual
Prefix:
First Name:LORELLE
Middle Name:
Last Name:SAXENA
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 1:98 MONTGOMERY DR STE B
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-6615
Mailing Address - Country:US
Mailing Address - Phone:707-575-4826
Mailing Address - Fax:
Practice Address - Street 1:98 MONTGOMERY DR STE B
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-6615
Practice Address - Country:US
Practice Address - Phone:707-575-4826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-24
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13077171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist