Provider Demographics
NPI:1841531654
Name:GREENSPAN, MECHELLE R (LAC)
Entity type:Individual
Prefix:
First Name:MECHELLE
Middle Name:R
Last Name:GREENSPAN
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 1:2362 SCOTT AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90026-2458
Mailing Address - Country:US
Mailing Address - Phone:310-880-2216
Mailing Address - Fax:
Practice Address - Street 1:2362 SCOTT AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90026-2458
Practice Address - Country:US
Practice Address - Phone:310-880-2216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-05
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14644171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist