Provider Demographics
NPI:1144770785
Name:BLIKIAN, KRISTINE (LAC)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:
Last Name:BLIKIAN
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 1:1600 VICTORY BLVD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91201-2915
Mailing Address - Country:US
Mailing Address - Phone:818-244-5300
Mailing Address - Fax:818-244-5353
Practice Address - Street 1:1600 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91201-2915
Practice Address - Country:US
Practice Address - Phone:818-244-5300
Practice Address - Fax:818-244-5353
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-06
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC-17070171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist