Provider Demographics
NPI:1871778969
Name:MARTIN, SACHIKO ITAYA (LAC)
Entity type:Individual
Prefix:MRS
First Name:SACHIKO
Middle Name:ITAYA
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:YUKI
Other - Middle Name:ITAYA
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2342 EUCALYPTUS AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-4218
Mailing Address - Country:US
Mailing Address - Phone:562-232-4568
Mailing Address - Fax:
Practice Address - Street 1:2342 EUCALYPTUS AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-4218
Practice Address - Country:US
Practice Address - Phone:562-232-4568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-08
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12083171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist