Healthcare Provider Details

I. General information

NPI: 1679918262
Provider Name (Legal Business Name): MARINA KUZNETSOVA LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2013
Last Update Date: 04/22/2025
Certification Date: 04/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3440 WILSHIRE BLVD STE 1207
LOS ANGELES CA
90010-2127
US

IV. Provider business mailing address

125 N GALE DR APT 401
BEVERLY HILLS CA
90211-2337
US

V. Phone/Fax

Practice location:
  • Phone: 213-480-3191
  • Fax:
Mailing address:
  • Phone: 310-999-3995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC7753
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: