Provider Demographics
NPI:1730449513
Name:LO, BETTY (LAC)
Entity type:Individual
Prefix:MS
First Name:BETTY
Middle Name:
Last Name:LO
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 1:358 LUDEMAN LN
Mailing Address - Street 2:
Mailing Address - City:MILLBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94030-1350
Mailing Address - Country:US
Mailing Address - Phone:650-922-4600
Mailing Address - Fax:
Practice Address - Street 1:358 LUDEMAN LN
Practice Address - Street 2:
Practice Address - City:MILLBRAE
Practice Address - State:CA
Practice Address - Zip Code:94030-1350
Practice Address - Country:US
Practice Address - Phone:650-922-4600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-25
Last Update Date:2012-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14461171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist