Provider Demographics
NPI:1841624814
Name:CANTER, ELIZABETH (LAC)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:CANTER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8885 RIO SAN DIEGO DR
Mailing Address - Street 2:STE 357
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-1624
Mailing Address - Country:US
Mailing Address - Phone:202-365-6938
Mailing Address - Fax:
Practice Address - Street 1:8885 RIO SAN DIEGO DR
Practice Address - Street 2:STE 357
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-1624
Practice Address - Country:US
Practice Address - Phone:202-365-6938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-27
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 14866171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist