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General NPI Number Information
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NPI Number | 1255563789
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Entity Type | Individual
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Provider Name | CAROLINE MARUYA L.AC.
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Gender | Female
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Dates
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Enumeration Date | 08/17/2009
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Last Update Date | 01/25/2024
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Provider Practice Location Address
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Address Line | 960 E GREEN ST STE 162
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City | PASADENA
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State | CA
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Zip | 91106-2407
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Country | US
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Telephone | 626-792-2932
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Fax | 626-792-2397
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Provider Business Mailing Address
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Address Line | 960 E GREEN ST STE 162
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City | PASADENA
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State | CA
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Zip | 91106-2407
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Country | US
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Telephone | 626-792-2932
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Fax | 626-792-2397
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC10154
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License Number State | CA
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