Provider Demographics
NPI:1346705662
Name:QUACH, SARIKA CHRISTINE (LAC)
Entity Type:Individual
Prefix:
First Name:SARIKA
Middle Name:CHRISTINE
Last Name:QUACH
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:PO BOX 250786
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91225-0786
Mailing Address - Country:US
Mailing Address - Phone:626-215-7039
Mailing Address - Fax:
Practice Address - Street 1:4443 AMBROSE AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-2114
Practice Address - Country:US
Practice Address - Phone:213-600-8288
Practice Address - Fax:213-289-1180
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-01
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18440171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist