Provider Demographics
NPI:1902130396
Name:BLAIR, SHERINE (LAC)
Entity Type:Individual
Prefix:MS
First Name:SHERINE
Middle Name:
Last Name:BLAIR
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:SHERINE
Other - Middle Name:
Other - Last Name:WONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:781 GARDEN VIEW CT
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-2481
Mailing Address - Country:US
Mailing Address - Phone:760-479-0133
Mailing Address - Fax:
Practice Address - Street 1:781 GARDEN VIEW CT
Practice Address - Street 2:SUITE 201
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-2481
Practice Address - Country:US
Practice Address - Phone:760-479-0133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-01
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC13201171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist