Provider Demographics
NPI:1245443308
Name:HEESEN L.AC., GAYATRI CHOPRA (LAC)
Entity type:Individual
Prefix:
First Name:GAYATRI
Middle Name:CHOPRA
Last Name:HEESEN L.AC.
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 1:300 E. CANON PERDIDO ST. E-1
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101
Mailing Address - Country:US
Mailing Address - Phone:805-965-0565
Mailing Address - Fax:805-965-6571
Practice Address - Street 1:300 E. CANON PERDIDO ST. E-1
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101
Practice Address - Country:US
Practice Address - Phone:805-965-0565
Practice Address - Fax:805-965-6571
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 7410171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC 7410OtherLICENSES NUMBER