Provider Demographics
NPI:1295579837
Name:POLIVA, KARINA (LAC)
Entity type:Individual
Prefix:
First Name:KARINA
Middle Name:
Last Name:POLIVA
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 1:39382 PROSPECT DR
Mailing Address - Street 2:
Mailing Address - City:FOREST FALLS
Mailing Address - State:CA
Mailing Address - Zip Code:92339-9698
Mailing Address - Country:US
Mailing Address - Phone:415-244-6719
Mailing Address - Fax:
Practice Address - Street 1:414 TENNESSEE ST STE E
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-8152
Practice Address - Country:US
Practice Address - Phone:415-244-6719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-19
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19868171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist