Provider Demographics
NPI:1548611155
Name:CAMPANALE, ANGELICA KEIKO (LAC)
Entity type:Individual
Prefix:MS
First Name:ANGELICA
Middle Name:KEIKO
Last Name:CAMPANALE
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 1:1034 W IOWA AVE
Mailing Address - Street 2:# 25
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94086-7475
Mailing Address - Country:US
Mailing Address - Phone:831-431-9021
Mailing Address - Fax:
Practice Address - Street 1:500 E REMINGTON DR
Practice Address - Street 2:SUITE 25
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-2657
Practice Address - Country:US
Practice Address - Phone:408-720-1766
Practice Address - Fax:408-720-1763
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-24
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC16677171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist