Provider Demographics
NPI:1083793053
Name:REZNIKOFF, MARC ERIN (AC)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:ERIN
Last Name:REZNIKOFF
Suffix:
Gender:M
Credentials:AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 MOHAWK
Mailing Address - Street 2:
Mailing Address - City:TOPANGA
Mailing Address - State:CA
Mailing Address - Zip Code:90290-4446
Mailing Address - Country:US
Mailing Address - Phone:661-267-6876
Mailing Address - Fax:661-267-0438
Practice Address - Street 1:1125 MOHAWK
Practice Address - Street 2:
Practice Address - City:TOPANGA
Practice Address - State:CA
Practice Address - Zip Code:90290-4446
Practice Address - Country:US
Practice Address - Phone:661-267-6876
Practice Address - Fax:661-267-0438
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 4547171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist