Provider Demographics
NPI:1023205598
Name:LIVNI, ELISHA (LAC)
Entity Type:Individual
Prefix:MR
First Name:ELISHA
Middle Name:
Last Name:LIVNI
Suffix:
Gender:M
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:PO BOX 2883
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95063-2883
Mailing Address - Country:US
Mailing Address - Phone:831-423-3777
Mailing Address - Fax:831-465-0686
Practice Address - Street 1:740 FRONT ST STE 350
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-4562
Practice Address - Country:US
Practice Address - Phone:831-423-3777
Practice Address - Fax:831-465-0686
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-28
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4600171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist