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General NPI Number Information
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NPI Number | 1760717532
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Entity Type | Individual
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Provider Name | VICKI A MAIERLE PERMANENT MAKE UP AR
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Gender | Female
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Dates
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Enumeration Date | 10/12/2009
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Last Update Date | 10/12/2009
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Provider Practice Location Address
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Address Line | 9834 GENESEE AVE SUITE 128
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City | LA JOLLA
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State | CA
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Zip | 92037-1223
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Country | US
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Telephone | 619-368-6269
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Fax | 858-457-0669
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Provider Business Mailing Address
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Address Line | 3970 NOBEL DR #102
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City | SAN DIEGO
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State | CA
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Zip | 92122-5789
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Country | US
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Telephone | 619-368-6269
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Fax | 858-457-0669
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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 | 171W00000X
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Taxonomy Name | Contractor
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License Number |
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License Number State |
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