Provider Demographics
NPI:1285927459
Name:MALINOWSKI, SUSAN LINDA (LAC)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:LINDA
Last Name:MALINOWSKI
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 1:11 PINEHILL WAY
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-4107
Mailing Address - Country:US
Mailing Address - Phone:831-402-5004
Mailing Address - Fax:
Practice Address - Street 1:11 PINEHILL WAY
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-4107
Practice Address - Country:US
Practice Address - Phone:831-402-5004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-20
Last Update Date:2011-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9149171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist