Provider Demographics
NPI:1740509090
Name:MORRIS, ANNIKA KISPERSKY (LAC)
Entity type:Individual
Prefix:
First Name:ANNIKA
Middle Name:KISPERSKY
Last Name:MORRIS
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 1:1307 INNES PL
Mailing Address - Street 2:UNIT A
Mailing Address - City:VENICE
Mailing Address - State:CA
Mailing Address - Zip Code:90291
Mailing Address - Country:US
Mailing Address - Phone:310-399-6864
Mailing Address - Fax:
Practice Address - Street 1:1307 INNES PL
Practice Address - Street 2:UNIT A
Practice Address - City:VENICE
Practice Address - State:CA
Practice Address - Zip Code:90291-3673
Practice Address - Country:US
Practice Address - Phone:310-399-6864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-26
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13509171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist