Provider Demographics
NPI:1104251859
Name:MITTICA, AARON MICHAEL (LAC, DIPL)
Entity type:Individual
Prefix:
First Name:AARON
Middle Name:MICHAEL
Last Name:MITTICA
Suffix:
Gender:M
Credentials:LAC, DIPL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 SCARLET OAK DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19444-2420
Mailing Address - Country:US
Mailing Address - Phone:610-761-0528
Mailing Address - Fax:
Practice Address - Street 1:2 SCARLET OAK DR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE HILL
Practice Address - State:PA
Practice Address - Zip Code:19444-2409
Practice Address - Country:US
Practice Address - Phone:610-825-5282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-12
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAK001092171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist