1104081843 NPI number — KATHLEEN RYAN LOWRY L.AC.DIPL.AC(NCCAOM)

Table of content: KATHLEEN RYAN LOWRY L.AC.DIPL.AC(NCCAOM) (NPI 1104081843)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104081843 NPI number — KATHLEEN RYAN LOWRY L.AC.DIPL.AC(NCCAOM)

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOWRY
Provider First Name:
KATHLEEN
Provider Middle Name:
RYAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
L.AC.DIPL.AC(NCCAOM)
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104081843
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/18/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 N PACIFIC COAST HWY
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
REDONDO BEACH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90277-3149
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-379-0559
Provider Business Mailing Address Fax Number:
310-379-9678

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 N PACIFIC COAST HWY
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
REDONDO BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90277-3149
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-379-0559
Provider Business Practice Location Address Fax Number:
310-379-9678
Provider Enumeration Date:
07/22/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171100000X , with the licence number:  AC3405 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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