Provider Demographics
NPI:1750532859
Name:MIK, KATIE L (LAC)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:L
Last Name:MIK
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Gender:F
Credentials:LAC
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Mailing Address - Street 1:1804 CABLE ST.
Mailing Address - Street 2:SUITE B
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92107
Mailing Address - Country:US
Mailing Address - Phone:619-243-5109
Mailing Address - Fax:619-243-5113
Practice Address - Street 1:317 N EL CAMINO REAL
Practice Address - Street 2:SUITE 401
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-2811
Practice Address - Country:US
Practice Address - Phone:760-635-0581
Practice Address - Fax:760-635-0587
Is Sole Proprietor?:No
Enumeration Date:2008-10-07
Last Update Date:2010-10-19
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Provider Licenses
StateLicense IDTaxonomies
CA12546171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist