Provider Demographics
NPI:1336105980
Name:MAROVIC, MIKICA (LAC)
Entity Type:Individual
Prefix:MRS
First Name:MIKICA
Middle Name:
Last Name:MAROVIC
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:855 BROOKLINE DR
Mailing Address - Street 2:APT I
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087-1201
Mailing Address - Country:US
Mailing Address - Phone:650-380-3055
Mailing Address - Fax:408-733-1638
Practice Address - Street 1:1314 LINCOLN AVE
Practice Address - Street 2:STE 2B
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-3012
Practice Address - Country:US
Practice Address - Phone:650-380-3055
Practice Address - Fax:408-733-1638
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 10535171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist