Healthcare Provider Details

I. General information

NPI: 1083042311
Provider Name (Legal Business Name): BODYWISE ACUPUNCTURE & TOTAL WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2013
Last Update Date: 11/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

885 CANARIOS CT STE. 110
CHULA VISTA CA
91910-7877
US

IV. Provider business mailing address

885 CANARIOS CT STE. 110
CHULA VISTA CA
91910-7877
US

V. Phone/Fax

Practice location:
  • Phone: 619-656-5102
  • Fax: 619-656-5143
Mailing address:
  • Phone: 619-656-5102
  • Fax: 619-656-5143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberAC15584
License Number StateCA

VIII. Authorized Official

Name: MS. GEORGIA GOOD
Title or Position: PRESIDENT
Credential: L.AC., DIPL. OM
Phone: 619-210-5153