Provider Demographics
NPI:1326584004
Name:MARSON, EMILY NICHOLS (LAC)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:NICHOLS
Last Name:MARSON
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:MS
Other - First Name:EMILY
Other - Middle Name:RANDALL
Other - Last Name:NICHOLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:1546 BANCROFT STREET
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92102
Mailing Address - Country:US
Mailing Address - Phone:860-305-1994
Mailing Address - Fax:
Practice Address - Street 1:3911 5TH AVE
Practice Address - Street 2:SUITE 208
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103
Practice Address - Country:US
Practice Address - Phone:858-333-7688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-18
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA17395171100000X
CAAC 17395171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist