Provider Demographics
NPI:1871354993
Name:CRONIN, PATRICIA KEIKO (LAC)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:KEIKO
Last Name:CRONIN
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 1:4612 GLENCOE AVE UNIT 1
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-6355
Mailing Address - Country:US
Mailing Address - Phone:310-729-3528
Mailing Address - Fax:
Practice Address - Street 1:13323 W WASHINGTON BLVD STE 202
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-5163
Practice Address - Country:US
Practice Address - Phone:310-729-3528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC-5416171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist