Provider Demographics
NPI:1811442833
Name:VLAHAKIS, MICHELLE (L AC)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:VLAHAKIS
Suffix:
Gender:F
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3677 1ST AVE APT 308
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-4031
Mailing Address - Country:US
Mailing Address - Phone:845-492-1409
Mailing Address - Fax:917-398-7730
Practice Address - Street 1:7323 ENGINEER RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-1409
Practice Address - Country:US
Practice Address - Phone:845-492-1409
Practice Address - Fax:917-398-7730
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-19
Last Update Date:2020-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005797171100000X
CA18908171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty