Provider Demographics
NPI:1619122363
Name:TANAKA NIELSEN, MAKI (LAC)
Entity Type:Individual
Prefix:MRS
First Name:MAKI
Middle Name:
Last Name:TANAKA NIELSEN
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 1:3257 CAMINO DE LOS COCHES
Mailing Address - Street 2:SUITE 203
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-8976
Mailing Address - Country:US
Mailing Address - Phone:760-944-2911
Mailing Address - Fax:760-944-3939
Practice Address - Street 1:3257 CAMINO DE LOS COCHES
Practice Address - Street 2:SUITE 203
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92009-8976
Practice Address - Country:US
Practice Address - Phone:760-944-2911
Practice Address - Fax:760-944-3939
Is Sole Proprietor?:No
Enumeration Date:2008-11-21
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC9215171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist