Provider Demographics
NPI:1831223478
Name:SOVICH, JAN ANTHONY (LAC,OMD,)
Entity type:Individual
Prefix:DR
First Name:JAN
Middle Name:ANTHONY
Last Name:SOVICH
Suffix:
Gender:M
Credentials:LAC,OMD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 MAPLE CT
Mailing Address - Street 2:SUITE 112
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-3516
Mailing Address - Country:US
Mailing Address - Phone:805-644-6969
Mailing Address - Fax:805-644-2811
Practice Address - Street 1:260 MAPLE CT
Practice Address - Street 2:SUITE 112
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-3516
Practice Address - Country:US
Practice Address - Phone:805-644-6969
Practice Address - Fax:805-644-2811
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC3478171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist