Provider Demographics
NPI:1407912595
Name:VICKERY, DIA (DACM, LAC)
Entity Type:Individual
Prefix:DR
First Name:DIA
Middle Name:
Last Name:VICKERY
Suffix:
Gender:F
Credentials:DACM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20750 VENTURA BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-6693
Mailing Address - Country:US
Mailing Address - Phone:818-578-6730
Mailing Address - Fax:818-578-6731
Practice Address - Street 1:20750 VENTURA BLVD STE 203
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-6693
Practice Address - Country:US
Practice Address - Phone:818-578-6730
Practice Address - Fax:818-578-6731
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-31
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC9644171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist