Provider Demographics
NPI:1316173198
Name:PIERSON, MARK ANDREW (LAC)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:ANDREW
Last Name:PIERSON
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5230 CARROLL CANYON RD STE 110
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-1779
Mailing Address - Country:US
Mailing Address - Phone:858-442-1488
Mailing Address - Fax:
Practice Address - Street 1:5230 CARROLL CANYON RD STE 110
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-1779
Practice Address - Country:US
Practice Address - Phone:858-442-1488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-07
Last Update Date:2009-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12888171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist