Provider Demographics
NPI:1750879813
Name:SCHULZE, ALIYA NAZERALI (LAC)
Entity type:Individual
Prefix:
First Name:ALIYA
Middle Name:NAZERALI
Last Name:SCHULZE
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 1:5451 LAURETTA ST APT 2
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-2456
Mailing Address - Country:US
Mailing Address - Phone:760-580-0650
Mailing Address - Fax:
Practice Address - Street 1:3555 KENYON ST STE 100
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-5341
Practice Address - Country:US
Practice Address - Phone:760-580-0650
Practice Address - Fax:888-557-2908
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-24
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17146171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1710498266OtherN/A