Provider Demographics
NPI:1831505858
Name:WREN, ASHLEY LYDIA (LAC)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:LYDIA
Last Name:WREN
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 1:10822 ROSE AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-5369
Mailing Address - Country:US
Mailing Address - Phone:310-936-5260
Mailing Address - Fax:
Practice Address - Street 1:1150 YALE ST STE 8
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-4768
Practice Address - Country:US
Practice Address - Phone:310-936-2387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-10
Last Update Date:2020-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15814171100000X
CAAC 15814171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist