Provider Demographics
NPI:1073044673
Name:LOYNAZ, POLET SOFIA (LAC)
Entity Type:Individual
Prefix:
First Name:POLET
Middle Name:SOFIA
Last Name:LOYNAZ
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 1:5620 MARENGO AVE
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-2314
Mailing Address - Country:US
Mailing Address - Phone:858-220-3927
Mailing Address - Fax:
Practice Address - Street 1:420 WALNUT AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-4987
Practice Address - Country:US
Practice Address - Phone:858-220-3927
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-24
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17312171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist