Provider Demographics
NPI:1063578698
Name:MASIULIS, ALICIA D (LAC LMP)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:D
Last Name:MASIULIS
Suffix:
Gender:F
Credentials:LAC LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1306
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94026-1306
Mailing Address - Country:US
Mailing Address - Phone:206-375-3689
Mailing Address - Fax:206-629-2190
Practice Address - Street 1:290 CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94306-1618
Practice Address - Country:US
Practice Address - Phone:650-605-7134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00017471225700000X
WAAC00002299171100000X
CA17059171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist