Provider Demographics
NPI:1568692341
Name:SIE, MIEKO MARTHA (LAC, HHP)
Entity Type:Individual
Prefix:MRS
First Name:MIEKO
Middle Name:MARTHA
Last Name:SIE
Suffix:
Gender:F
Credentials:LAC, HHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 N EL CAMINO REAL STE 406
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-2815
Mailing Address - Country:US
Mailing Address - Phone:858-229-1172
Mailing Address - Fax:858-794-9453
Practice Address - Street 1:317 N EL CAMINO REAL STE 406
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-2815
Practice Address - Country:US
Practice Address - Phone:858-229-1172
Practice Address - Fax:858-272-9396
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-15
Last Update Date:2010-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC12263171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist