Provider Demographics
NPI:1043797962
Name:SMELOFF, MAYA NATALIA (LAC)
Entity Type:Individual
Prefix:
First Name:MAYA
Middle Name:NATALIA
Last Name:SMELOFF
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 1:5703 1/2 VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90038-2908
Mailing Address - Country:US
Mailing Address - Phone:415-939-3107
Mailing Address - Fax:
Practice Address - Street 1:5703 1/2 VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90038-2908
Practice Address - Country:US
Practice Address - Phone:415-939-3107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-24
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19523171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty