Healthcare Provider Details

I. General information

NPI: 1063817658
Provider Name (Legal Business Name): GLORIA YEE HOANG L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2014
Last Update Date: 10/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 CAMINO DEL MAR SUITE H
DEL MAR CA
92014-2800
US

IV. Provider business mailing address

5021 BARSTOW ST
SAN DIEGO CA
92117-1424
US

V. Phone/Fax

Practice location:
  • Phone: 858-336-6288
  • Fax:
Mailing address:
  • Phone: 858-336-6288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC16180
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: