Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 19528 | CA |
NPI | 1740358720 |
---|---|
Provider Name | Dr. Staci Marazoni Paciorek |
First Address | Valley Village, CA 91607-3327 |
Second Address | Valley Village, CA 91607-3327 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2006 |
Last Update Date | 15/06/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DC019528 | BLUE SHIELD (01) | CA |
DC19528 | (02) | CA |