Provider Demographics
NPI:1760717532
Name:MAIERLE, VICKI A (PERMANENT MAKE UP AR)
Entity Type:Individual
Prefix:MS
First Name:VICKI
Middle Name:A
Last Name:MAIERLE
Suffix:
Gender:F
Credentials:PERMANENT MAKE UP AR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3970 NOBEL DR
Mailing Address - Street 2:#102
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-5789
Mailing Address - Country:US
Mailing Address - Phone:619-368-6269
Mailing Address - Fax:858-457-0669
Practice Address - Street 1:9834 GENESEE AVE
Practice Address - Street 2:SUITE 128
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1223
Practice Address - Country:US
Practice Address - Phone:619-368-6269
Practice Address - Fax:858-457-0669
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-12
Last Update Date:2009-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor