Provider Demographics
NPI:1821217878
Name:HOVERSEN, MAUREEN (LAC)
Entity Type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:
Last Name:HOVERSEN
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 1:501 CEDAR ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-4358
Mailing Address - Country:US
Mailing Address - Phone:831-426-1093
Mailing Address - Fax:
Practice Address - Street 1:501 CEDAR ST
Practice Address - Street 2:SUITE B
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-4358
Practice Address - Country:US
Practice Address - Phone:831-426-1093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7929171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist