Provider Demographics
NPI:1376258343
Name:MARUOKA, ETSUKO (LAC)
Entity Type:Individual
Prefix:
First Name:ETSUKO
Middle Name:
Last Name:MARUOKA
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 1:6509 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-4843
Mailing Address - Country:US
Mailing Address - Phone:240-461-9392
Mailing Address - Fax:
Practice Address - Street 1:8811 COLESVILLE RD STE 116
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-4327
Practice Address - Country:US
Practice Address - Phone:240-461-9392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-13
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU02972171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty