Healthcare Provider Details

I. General information

NPI: 1093444028
Provider Name (Legal Business Name): KRISTEN CERNA DACM, LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KRISTEN MAURER DACM, LAC

II. Dates (important events)

Enumeration Date: 06/06/2022
Last Update Date: 05/16/2023
Certification Date: 05/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 LA VETA AVE
ENCINITAS CA
92024-2014
US

IV. Provider business mailing address

885 REQUEZA ST
ENCINITAS CA
92024-3838
US

V. Phone/Fax

Practice location:
  • Phone: 760-652-1116
  • Fax:
Mailing address:
  • Phone: 513-607-8283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number19422
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: