Healthcare Provider Details

I. General information

NPI: 1114134517
Provider Name (Legal Business Name): INGRID GRACE SHEQUIN L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 HYMETTUS AVE
ENCINITAS CA
92024-1747
US

IV. Provider business mailing address

1301 HYMETTUS AVE
ENCINITAS CA
92024-1747
US

V. Phone/Fax

Practice location:
  • Phone: 760-944-3840
  • Fax: 760-944-3840
Mailing address:
  • Phone: 760-944-3840
  • Fax: 760-944-3840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC 4326
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: