Provider Demographics
NPI:1982108189
Name:PLICHTA, ANDREA IRENE (LAC)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:IRENE
Last Name:PLICHTA
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 1:6830 LA JOLLA BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-6156
Mailing Address - Country:US
Mailing Address - Phone:858-459-0899
Mailing Address - Fax:
Practice Address - Street 1:6830 LA JOLLA BLVD STE 201
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-6156
Practice Address - Country:US
Practice Address - Phone:858-459-0899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-21
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12759171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist