Provider Demographics
NPI:1063858496
Name:MILIOTIS, ANDREA WERNER (LAC)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:WERNER
Last Name:MILIOTIS
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 1:239 CONEFLOWER ST
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-3302
Mailing Address - Country:US
Mailing Address - Phone:760-704-7712
Mailing Address - Fax:
Practice Address - Street 1:451 LA VETA AVE
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-2014
Practice Address - Country:US
Practice Address - Phone:760-704-7712
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-13
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 10913171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist