Provider Demographics
NPI:1487059473
Name:STACEY, TOBE (LAC)
Entity type:Individual
Prefix:
First Name:TOBE
Middle Name:
Last Name:STACEY
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 1:407 POTTER ST
Mailing Address - Street 2:STE.D
Mailing Address - City:FALLBROOK
Mailing Address - State:CA
Mailing Address - Zip Code:92028
Mailing Address - Country:US
Mailing Address - Phone:760-723-6557
Mailing Address - Fax:
Practice Address - Street 1:407 POTTER ST
Practice Address - Street 2:STE. D
Practice Address - City:FALLBROOK
Practice Address - State:CA
Practice Address - Zip Code:92028
Practice Address - Country:US
Practice Address - Phone:760-723-6557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-03
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC16135171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist