Provider Demographics
NPI:1770988313
Name:PENDLETON, ANNE (LAC)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:PENDLETON
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 1:23760 ALAMITOS RD APT 15
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95120-5200
Mailing Address - Country:US
Mailing Address - Phone:408-500-2480
Mailing Address - Fax:
Practice Address - Street 1:88 W 2ND ST
Practice Address - Street 2:
Practice Address - City:MORGAN HILL
Practice Address - State:CA
Practice Address - Zip Code:95037-4504
Practice Address - Country:US
Practice Address - Phone:408-500-2480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-24
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15955171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist