Provider Demographics
NPI:1831578939
Name:REESE, LAURA EMILY (LAC)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:EMILY
Last Name:REESE
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 1:653 65TH ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-1036
Mailing Address - Country:US
Mailing Address - Phone:510-220-5224
Mailing Address - Fax:
Practice Address - Street 1:4315 PIEDMONT AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-4776
Practice Address - Country:US
Practice Address - Phone:510-220-5224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-21
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12891171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist