Provider Demographics
NPI:1710236955
Name:MARUKI, GREGORY GEORGE (LAC)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:GEORGE
Last Name:MARUKI
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2832 E CHAPMAN AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92869-3211
Mailing Address - Country:US
Mailing Address - Phone:323-896-1279
Mailing Address - Fax:
Practice Address - Street 1:2832 E CHAPMAN AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92869-3211
Practice Address - Country:US
Practice Address - Phone:323-896-1279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-04
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14912171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist