Provider Demographics
NPI:1649627589
Name:MARUYAMA, CHIZURU
Entity type:Individual
Prefix:MS
First Name:CHIZURU
Middle Name:
Last Name:MARUYAMA
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:CHIZURU
Other - Middle Name:
Other - Last Name:MARUYAMA-ALI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17502 IRVINE BLVD
Mailing Address - Street 2:STE A
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3127
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17502 IRVINE BLVD
Practice Address - Street 2:STE A
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3127
Practice Address - Country:US
Practice Address - Phone:949-241-3344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-20
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17108171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist