Provider Demographics
NPI:1619354917
Name:RUSKIN, MARK JEFFREY (LAC)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:JEFFREY
Last Name:RUSKIN
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5121 EVALITA LN
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93111-2515
Mailing Address - Country:US
Mailing Address - Phone:805-964-9987
Mailing Address - Fax:805-964-9965
Practice Address - Street 1:5121 EVALITA LN
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93111-2515
Practice Address - Country:US
Practice Address - Phone:805-964-9987
Practice Address - Fax:805-964-9965
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-06
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC5757171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist