Provider Demographics
NPI:1952726838
Name:HARDING, CYRIL VAN (LAC)
Entity Type:Individual
Prefix:MR
First Name:CYRIL
Middle Name:VAN
Last Name:HARDING
Suffix:
Gender:M
Credentials:LAC
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Mailing Address - Street 1:2554 LINCOLN BLVD
Mailing Address - Street 2:#211
Mailing Address - City:VENICE
Mailing Address - State:CA
Mailing Address - Zip Code:90291-5043
Mailing Address - Country:US
Mailing Address - Phone:310-310-8096
Mailing Address - Fax:310-310-8096
Practice Address - Street 1:2990 S SEPULVEDA BLVD
Practice Address - Street 2:#310
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-0002
Practice Address - Country:US
Practice Address - Phone:310-310-8096
Practice Address - Fax:310-310-8096
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-28
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA15627171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist