Provider Demographics
NPI:1447695382
Name:GALLENSON, ROCHELLE MARIE (LAC, DIPLM OM)
Entity type:Individual
Prefix:
First Name:ROCHELLE
Middle Name:MARIE
Last Name:GALLENSON
Suffix:
Gender:F
Credentials:LAC, DIPLM OM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3936 INGLEWOOD BLVD
Mailing Address - Street 2:UNIT 7
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-4550
Mailing Address - Country:US
Mailing Address - Phone:424-625-9812
Mailing Address - Fax:
Practice Address - Street 1:13115 W WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-5125
Practice Address - Country:US
Practice Address - Phone:424-625-9812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-06
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15268171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist