Provider Demographics
NPI:1457472417
Name:SUGICH, JACQUELYN LEIGH (LAC)
Entity type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:LEIGH
Last Name:SUGICH
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 1:133 E DE LA GUERRA ST
Mailing Address - Street 2:PMB 402
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101-2228
Mailing Address - Country:US
Mailing Address - Phone:805-708-1516
Mailing Address - Fax:
Practice Address - Street 1:2015A STATE ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-3553
Practice Address - Country:US
Practice Address - Phone:805-708-1516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC11332171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist