Provider Demographics
NPI:1124352745
Name:MARICHIBA, SERINA (LAC, DIPOM)
Entity type:Individual
Prefix:
First Name:SERINA
Middle Name:
Last Name:MARICHIBA
Suffix:
Gender:F
Credentials:LAC, DIPOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1122 SEABRIGHT AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-2506
Mailing Address - Country:US
Mailing Address - Phone:831-325-9338
Mailing Address - Fax:
Practice Address - Street 1:115 MAPLE ST
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-4424
Practice Address - Country:US
Practice Address - Phone:831-325-9338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-29
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13175171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist