Provider Demographics
NPI:1700265238
Name:MANKA-SEGAL, SAMANTHA LEIGH (LAC; DIPLOM)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:LEIGH
Last Name:MANKA-SEGAL
Suffix:
Gender:F
Credentials:LAC; DIPLOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3221 CARTER AVE UNIT 429
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-4969
Mailing Address - Country:US
Mailing Address - Phone:323-229-8346
Mailing Address - Fax:
Practice Address - Street 1:3221 CARTER AVE UNIT 429
Practice Address - Street 2:
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-4969
Practice Address - Country:US
Practice Address - Phone:323-229-8346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-29
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16607171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist