Provider Demographics
NPI:1235645938
Name:FOITZIK, MONICA DUMALA (LAC)
Entity Type:Individual
Prefix:MS
First Name:MONICA
Middle Name:DUMALA
Last Name:FOITZIK
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 1:3861 RIVIERA DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-6302
Mailing Address - Country:US
Mailing Address - Phone:760-696-1993
Mailing Address - Fax:
Practice Address - Street 1:1707 GRAND AVE STE A
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-4469
Practice Address - Country:US
Practice Address - Phone:760-696-1993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-18
Last Update Date:2017-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC16860171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist