Provider Demographics
NPI:1952328882
Name:FLEETMAN, AMY (LAC, OMD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:
Last Name:FLEETMAN
Suffix:
Gender:F
Credentials:LAC, OMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12215 VENTURA BLVD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-2533
Mailing Address - Country:US
Mailing Address - Phone:818-505-0816
Mailing Address - Fax:818-505-8623
Practice Address - Street 1:12215 VENTURA BLVD
Practice Address - Street 2:SUITE 208
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-2533
Practice Address - Country:US
Practice Address - Phone:818-505-0816
Practice Address - Fax:818-505-8623
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC4970171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist