Provider Demographics
NPI:1255563789
Name:MARUYA, CAROLINE (LAC)
Entity type:Individual
Prefix:MS
First Name:CAROLINE
Middle Name:
Last Name:MARUYA
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 1:960 E GREEN ST STE 162
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-2407
Mailing Address - Country:US
Mailing Address - Phone:626-792-2932
Mailing Address - Fax:626-792-2397
Practice Address - Street 1:960 E GREEN ST STE 162
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-2407
Practice Address - Country:US
Practice Address - Phone:626-792-2932
Practice Address - Fax:626-792-2397
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-17
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC10154171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist