Provider Demographics
NPI:1174351514
Name:THOMPSON, CLAIRE BULLARD (LAC)
Entity type:Individual
Prefix:
First Name:CLAIRE
Middle Name:BULLARD
Last Name:THOMPSON
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 1:401 S ARDMORE AVE APT 210
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-3242
Mailing Address - Country:US
Mailing Address - Phone:646-339-5439
Mailing Address - Fax:
Practice Address - Street 1:336 S EUCLID AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-3125
Practice Address - Country:US
Practice Address - Phone:626-822-9699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-25
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48759225700000X
CA20088171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist