Provider Demographics
NPI:1003271917
Name:UEJO MARCHAND, KERI (LAC, DIPL OM)
Entity Type:Individual
Prefix:
First Name:KERI
Middle Name:
Last Name:UEJO MARCHAND
Suffix:
Gender:F
Credentials:LAC, DIPL OM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1112 MONTANA AVE STE 528
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-7326
Mailing Address - Country:US
Mailing Address - Phone:310-401-4065
Mailing Address - Fax:
Practice Address - Street 1:1554 S SEPULVEDA BLVD STE 209
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-3359
Practice Address - Country:US
Practice Address - Phone:310-401-4065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-18
Last Update Date:2019-02-26
Deactivation Date:2016-02-22
Deactivation Code:
Reactivation Date:2017-10-11
Provider Licenses
StateLicense IDTaxonomies
CA16926171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist