Healthcare Provider Details

I. General information

NPI: 1649627589
Provider Name (Legal Business Name): MS. CHIZURU MARUYAMA SUKAUSKAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. CHIZURU MARUYAMA

II. Dates (important events)

Enumeration Date: 05/20/2016
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17502 IRVINE BLVD STE A
TUSTIN CA
92780-3127
US

IV. Provider business mailing address

17502 IRVINE BLVD STE A
TUSTIN CA
92780-3127
US

V. Phone/Fax

Practice location:
  • Phone: 949-241-3344
  • Fax:
Mailing address:
  • Phone: 949-241-3344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number17108
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: