Provider Demographics
NPI:1710286547
Name:CEN, MARY DING (LAC LICENSED ACUPU)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:DING
Last Name:CEN
Suffix:
Gender:F
Credentials:LAC LICENSED ACUPU
Other - Prefix:
Other - First Name:ZHENGZHONG
Other - Middle Name:
Other - Last Name:DING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:375 S. RANCHO SANTA FE RD.
Mailing Address - Street 2:# 104
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-2345
Mailing Address - Country:US
Mailing Address - Phone:760-744-4988
Mailing Address - Fax:760-744-4988
Practice Address - Street 1:375 S. RANCHO SANTA FE RD.
Practice Address - Street 2:# 104
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-2345
Practice Address - Country:US
Practice Address - Phone:760-744-4988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-18
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC1343171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist