1154595361 NPI number — MS. LORI L MUELLER DAOM, LAC, MBA

Table of content: MS. LORI L MUELLER DAOM, LAC, MBA (NPI 1154595361)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154595361 NPI number — MS. LORI L MUELLER DAOM, LAC, MBA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MUELLER
Provider First Name:
LORI
Provider Middle Name:
L
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
DAOM, LAC, MBA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GRITZ
Provider Other First Name:
LORI
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DAOM, LAC, MBA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1154595361
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/15/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1670 KETTNER BLVD
Provider Second Line Business Mailing Address:
APT 507
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92101-2560
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-829-4418
Provider Business Mailing Address Fax Number:
619-421-0434

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1670 KETTNER BLVD
Provider Second Line Business Practice Location Address:
APT 507
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92101-2560
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-829-4418
Provider Business Practice Location Address Fax Number:
619-421-0434
Provider Enumeration Date:
04/17/2008

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:  AC8930 , 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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