Provider Demographics
NPI:1487059945
Name:MISRA, LONIKA (LAC)
Entity type:Individual
Prefix:
First Name:LONIKA
Middle Name:
Last Name:MISRA
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 VIA DEL CABALLO
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-8915
Mailing Address - Country:US
Mailing Address - Phone:630-640-7583
Mailing Address - Fax:
Practice Address - Street 1:603 VIA DEL CABALLO
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-8915
Practice Address - Country:US
Practice Address - Phone:630-640-7583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-27
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14946171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist