Provider Demographics
NPI:1104179266
Name:HELGESON, MAILE ANNE (LAC)
Entity Type:Individual
Prefix:MS
First Name:MAILE
Middle Name:ANNE
Last Name:HELGESON
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 1:4656 PARK BLVD APT 3
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92116-2633
Mailing Address - Country:US
Mailing Address - Phone:619-471-4721
Mailing Address - Fax:
Practice Address - Street 1:4656 PARK BLVD APT 3
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92116-2633
Practice Address - Country:US
Practice Address - Phone:619-471-4721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-25
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14651171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist