Provider Demographics
NPI:1275740003
Name:MAR, JUDY Y (L AC)
Entity Type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:Y
Last Name:MAR
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 1:924 BERENICE DR
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-2203
Mailing Address - Country:US
Mailing Address - Phone:562-690-3498
Mailing Address - Fax:562-691-0588
Practice Address - Street 1:924 BERENICE DR
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-2203
Practice Address - Country:US
Practice Address - Phone:562-500-8752
Practice Address - Fax:562-691-0588
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 969171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist