Provider Demographics
NPI:1255647244
Name:BERLONGHI, LORETTA JENSEN (LAC)
Entity type:Individual
Prefix:
First Name:LORETTA
Middle Name:JENSEN
Last Name:BERLONGHI
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 1:2802 STATE ST STE C
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-1664
Mailing Address - Country:US
Mailing Address - Phone:760-729-8284
Mailing Address - Fax:
Practice Address - Street 1:2802 STATE ST STE C
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-1664
Practice Address - Country:US
Practice Address - Phone:760-729-8284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-27
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 9600171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist