Provider Demographics
NPI:1477868495
Name:MARRS, LEONA KIMI (MS, LAC)
Entity Type:Individual
Prefix:
First Name:LEONA
Middle Name:KIMI
Last Name:MARRS
Suffix:
Gender:F
Credentials:MS, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3127 GLENDALE BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90039-1857
Mailing Address - Country:US
Mailing Address - Phone:206-383-6746
Mailing Address - Fax:
Practice Address - Street 1:2820 GLENDALE BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90039-2723
Practice Address - Country:US
Practice Address - Phone:206-383-6746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-13
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12790171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist