Healthcare Provider Details

I. General information

NPI: 1790452357
Provider Name (Legal Business Name): ISLAND ACUPUNCTURE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2021
Last Update Date: 08/23/2021
Certification Date: 08/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1222 1ST ST STE 6
CORONADO CA
92118-1491
US

IV. Provider business mailing address

1222 1ST ST STE 6
CORONADO CA
92118-1491
US

V. Phone/Fax

Practice location:
  • Phone: 619-435-2522
  • Fax: 619-435-2511
Mailing address:
  • Phone: 619-435-2522
  • Fax: 619-435-2511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. GILA CAPLAN
Title or Position: OWNER
Credential: DAOM
Phone: 619-435-2522