Provider Demographics
NPI:1235299611
Name:POTYK, LISAJEANNE (L AC)
Entity Type:Individual
Prefix:MISS
First Name:LISAJEANNE
Middle Name:
Last Name:POTYK
Suffix:
Gender:F
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-3911
Mailing Address - Country:US
Mailing Address - Phone:619-440-4333
Mailing Address - Fax:619-440-4099
Practice Address - Street 1:251 E MAIN ST
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-3911
Practice Address - Country:US
Practice Address - Phone:619-440-4333
Practice Address - Fax:619-440-4099
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7703171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist