Provider Demographics
NPI:1093934424
Name:MERCHANT, MAIJA CAROL (LAC)
Entity Type:Individual
Prefix:MS
First Name:MAIJA
Middle Name:CAROL
Last Name:MERCHANT
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 1:9329 VALJEAN AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91343-2834
Mailing Address - Country:US
Mailing Address - Phone:323-365-1095
Mailing Address - Fax:
Practice Address - Street 1:9329 VALJEAN AVE
Practice Address - Street 2:
Practice Address - City:NORTH HILLS
Practice Address - State:CA
Practice Address - Zip Code:91343-2834
Practice Address - Country:US
Practice Address - Phone:323-365-1095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC11601171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist