Provider Demographics
NPI:1144281536
Name:WILCOX, LORRAINE (LAC)
Entity type:Individual
Prefix:
First Name:LORRAINE
Middle Name:
Last Name:WILCOX
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 1:2354 VIRGINIA AVE
Mailing Address - Street 2:APT 7
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-5156
Mailing Address - Country:US
Mailing Address - Phone:310-804-4734
Mailing Address - Fax:
Practice Address - Street 1:2354 VIRGINIA AVE
Practice Address - Street 2:APT 7
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-5156
Practice Address - Country:US
Practice Address - Phone:310-804-4734
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC3710171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist