Provider Demographics
NPI:1508178856
Name:MAGUIRE, MICHAEL (AC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:MAGUIRE
Suffix:
Gender:M
Credentials:AC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:28990 PACIFIC COAST HWY
Mailing Address - Street 2:STE 205
Mailing Address - City:MALIBU
Mailing Address - State:CA
Mailing Address - Zip Code:90265-3952
Mailing Address - Country:US
Mailing Address - Phone:310-589-1005
Mailing Address - Fax:310-589-1009
Practice Address - Street 1:28990 PACIFIC COAST HWY
Practice Address - Street 2:STE 205
Practice Address - City:MALIBU
Practice Address - State:CA
Practice Address - Zip Code:90265-3952
Practice Address - Country:US
Practice Address - Phone:310-589-1005
Practice Address - Fax:310-589-1009
Is Sole Proprietor?:No
Enumeration Date:2010-07-01
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC5337171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA954877872OtherTAX ID